Avita Medical Clinic LLC

NPI #1992302574 in Tampa, Florida

Provider Information

NPI Number: 1992302574
Entity Type: Organization
Organization Name: Avita Medical Clinic LLC
Primary Specialty: General Practice
Enumeration Date: Oct 6, 2020
Last Updated: Sep 2, 2021

Practice Location

Address: 14831 N FLORIDA AVE
City: Tampa
State: Florida
ZIP Code: 33613-1825
Phone: (813) 330-2737

Authorized Official

Name: JENNY M SEGARRA
Title: PRESIDENT
Phone: (813) 330-2737

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X
Occupational Therapist	225X00000X
General Practice	208D00000X	Primary

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