Provider Demographics
NPI:1649432576
Name:PELVIC REHABILITATION OF TAMPA LLC
Entity type:Organization
Organization Name:PELVIC REHABILITATION OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TARRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-854-1625
Mailing Address - Street 1:13049 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4451
Mailing Address - Country:US
Mailing Address - Phone:813-854-1625
Mailing Address - Fax:813-855-4396
Practice Address - Street 1:13049 W LINEBAUGH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4451
Practice Address - Country:US
Practice Address - Phone:813-854-1625
Practice Address - Fax:813-855-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy