Provider Demographics
NPI:1316098239
Name:PINELLAS PHYSIATRY ASSOCIATES PA
Entity type:Organization
Organization Name:PINELLAS PHYSIATRY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-327-2600
Mailing Address - Street 1:PO BOX 100267
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0267
Mailing Address - Country:US
Mailing Address - Phone:727-327-2600
Mailing Address - Fax:
Practice Address - Street 1:4400 140TH AVE N
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3832
Practice Address - Country:US
Practice Address - Phone:727-327-2600
Practice Address - Fax:727-327-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1477097OtherUNITED HEALTHCARE
FL2557884OtherAETNA
FL252977700Medicaid
FL21173Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER