Provider Demographics
NPI:1134428089
Name:TAMPA MASSAGE REHAB SERVICES
Entity type:Organization
Organization Name:TAMPA MASSAGE REHAB SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:YSMARAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-374-9000
Mailing Address - Street 1:4523 DREISLER ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7317
Mailing Address - Country:US
Mailing Address - Phone:813-506-4419
Mailing Address - Fax:
Practice Address - Street 1:4523 DREISLER ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7317
Practice Address - Country:US
Practice Address - Phone:813-506-4419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62393302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization