Southern Advanced Rehabilitation Corp

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

ME107516 Issued in FL

Legal business name

SOUTHERN ADVANCED REHABILITATION CORP

Practice address

10723 Cory Lake Dr
Tampa, FL 33647-2725

Phone

(813) 986-4648

Fax

(813) 986-4648

NPI assigned

Jul 7, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jose Manuel Medina, M.D.

Title

President & Director

Phone

(813) 986-4648

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1679956841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10723 CORY LAKE DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472725",
            "telephone_number": "813-986-4648",
            "fax_number": "813-986-4648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10723 CORY LAKE DR",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336472725",
            "telephone_number": "813-986-4648",
            "fax_number": "813-986-4648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ADVANCED REHABILITATION CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "MANUEL",
        "authorized_official_title_or_position": "PRESIDENT & DIRECTOR",
        "authorized_official_telephone_number": "813-986-4648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "ME107516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.