Provider Demographics
NPI:1891849527
Name:P&G MEDICAL REHAB CENTER, INC
Entity Type:Organization
Organization Name:P&G MEDICAL REHAB CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:V
Authorized Official - Last Name:PUJOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-935-8001
Mailing Address - Street 1:2901 W BUSCH BLVD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4523
Mailing Address - Country:US
Mailing Address - Phone:813-935-8001
Mailing Address - Fax:813-935-8948
Practice Address - Street 1:2901 W BUSCH BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-4523
Practice Address - Country:US
Practice Address - Phone:813-935-8001
Practice Address - Fax:813-935-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4524261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation