Provider Demographics
NPI:1750613055
Name:WESTPORT HOLDINGS TAMPA, LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:WESTPORT HOLDINGS TAMPA, LIMITED PARTNERSHIP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-975-5475
Mailing Address - Street 1:12401 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4670
Mailing Address - Country:US
Mailing Address - Phone:813-975-5475
Mailing Address - Fax:813-977-2688
Practice Address - Street 1:12401 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4670
Practice Address - Country:US
Practice Address - Phone:813-975-5475
Practice Address - Fax:813-977-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation