Provider Demographics
NPI:1275933681
Name:TAMPA SPORT & SPINE
Entity Type:Organization
Organization Name:TAMPA SPORT & SPINE
Other - Org Name:LEVICK PERFORMANCE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:JOURDAN
Authorized Official - Last Name:LEVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-230-3607
Mailing Address - Street 1:170 ACKLINS CIR
Mailing Address - Street 2:APARTMENT 308
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9781
Mailing Address - Country:US
Mailing Address - Phone:813-230-3607
Mailing Address - Fax:
Practice Address - Street 1:949 BEVILLE RD
Practice Address - Street 2:D5
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1705
Practice Address - Country:US
Practice Address - Phone:813-230-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10885261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center