| NPI | 1083040091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YADENIS JIMENEZ Administrator 813-765-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: FL MM31033) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2020-10-06 |