Provider Demographics
NPI:1861685885
Name:TPC PHYSICAL THERAPY & REHABILITATION, P.A.
Entity Type:Organization
Organization Name:TPC PHYSICAL THERAPY & REHABILITATION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:P
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:941-408-8800
Mailing Address - Street 1:4119 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5109
Mailing Address - Country:US
Mailing Address - Phone:941-408-8800
Mailing Address - Fax:941-408-0255
Practice Address - Street 1:4119 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5109
Practice Address - Country:US
Practice Address - Phone:941-408-8800
Practice Address - Fax:941-408-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8941ZMedicare PIN