Provider Demographics
NPI:1780066597
Name:TAMPA BAY SPINE AND INJURY
Entity type:Organization
Organization Name:TAMPA BAY SPINE AND INJURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:OBRIEN
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-381-3852
Mailing Address - Street 1:1532 OAKFIELD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-0829
Mailing Address - Country:US
Mailing Address - Phone:813-381-3852
Mailing Address - Fax:813-381-3873
Practice Address - Street 1:1532 OAKFIELD DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0829
Practice Address - Country:US
Practice Address - Phone:813-381-3852
Practice Address - Fax:813-381-3873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO3574207R00000X
FLPTA23287225200000X
FLAL33522255A2300X
FLPT3274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty