Provider Demographics
NPI:1821696907
Name:PHYSIOMATIC HIGH PERFORMANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PHYSIOMATIC HIGH PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-244-0871
Mailing Address - Street 1:13335 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9676
Mailing Address - Country:US
Mailing Address - Phone:727-244-0871
Mailing Address - Fax:
Practice Address - Street 1:13335 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9676
Practice Address - Country:US
Practice Address - Phone:727-244-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy