Provider Demographics
NPI:1811535719
Name:ORTHO IMPULSA LLC
Entity type:Organization
Organization Name:ORTHO IMPULSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-241-1414
Mailing Address - Street 1:4450 E FLETCHER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4907
Mailing Address - Country:US
Mailing Address - Phone:813-241-1414
Mailing Address - Fax:813-336-2112
Practice Address - Street 1:4450 E FLETCHER AVE STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4907
Practice Address - Country:US
Practice Address - Phone:813-241-1414
Practice Address - Fax:813-336-2112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOLINKS ORTHOPEDICS AND REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty