Provider Demographics
NPI:1699048447
Name:GSA REHABILITATION & PAIN MANAGEMENT
Entity type:Organization
Organization Name:GSA REHABILITATION & PAIN MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AVELINO
Authorized Official - Middle Name:T
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:813-918-5880
Mailing Address - Street 1:10511 CORAL KEY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3461
Mailing Address - Country:US
Mailing Address - Phone:813-926-8701
Mailing Address - Fax:813-333-1127
Practice Address - Street 1:1045 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7703
Practice Address - Country:US
Practice Address - Phone:813-918-5878
Practice Address - Fax:813-333-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty