Provider Demographics
NPI:1194932426
Name:FARESE PHYSICAL THERAPY CENTER, INC.
Entity type:Organization
Organization Name:FARESE PHYSICAL THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARESE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:727-381-5272
Mailing Address - Street 1:3641 TYRONE BLVD N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1126
Mailing Address - Country:US
Mailing Address - Phone:727-381-5272
Mailing Address - Fax:727-381-7195
Practice Address - Street 1:3641 TYRONE BLVD N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1126
Practice Address - Country:US
Practice Address - Phone:727-381-5272
Practice Address - Fax:727-381-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0004310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881403100Medicaid