| NPI | 1689187189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMMY MICHAEL LANE Owner 813-968-4293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 111N00000X Chiropractor |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2017-12-26 |