Provider Demographics
NPI:1841966520
Name:TAMPA BAY PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:TAMPA BAY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:PEARCE BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:352-426-1751
Mailing Address - Street 1:20110 BLUE DAZE AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2965
Mailing Address - Country:US
Mailing Address - Phone:352-426-1751
Mailing Address - Fax:
Practice Address - Street 1:13328 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0938
Practice Address - Country:US
Practice Address - Phone:352-426-1751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-21
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty