Provider Demographics
NPI:1063991875
Name:PHYSICAL MEDICINE & REHAB CONSULTANTS LLC
Entity type:Organization
Organization Name:PHYSICAL MEDICINE & REHAB CONSULTANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:J DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:813-459-7711
Mailing Address - Street 1:16734 IVY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-6020
Mailing Address - Country:US
Mailing Address - Phone:813-459-7711
Mailing Address - Fax:813-235-4175
Practice Address - Street 1:2202 DUCK SLOUGH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5071
Practice Address - Country:US
Practice Address - Phone:813-459-7711
Practice Address - Fax:813-235-4175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty