Provider Demographics
NPI:1902404163
Name:FRONTLINE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:FRONTLINE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHASTRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-608-8614
Mailing Address - Street 1:8655 BAYOU WAY N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4549
Mailing Address - Country:US
Mailing Address - Phone:727-608-8614
Mailing Address - Fax:
Practice Address - Street 1:1603 INDIAN ROCKS RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1026
Practice Address - Country:US
Practice Address - Phone:727-754-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy