Organization
PHYSICAL MEDICINE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CARL LUPO D.C. (OWNER/CLINIC DIRECTOR)
(813) 978-0020
Entity
Organization
Contact information
Practice address
14522 UNIVERSITY POINT PL, TAMPA, FL 33613-5425
(813) 978-0020
(813) 972-9024
Mailing address
14522 UNIVERSITY POINT PL, TAMPA, FL 33613-5425
(813) 978-0020
(813) 972-9024
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12043
BCBS
FL
01
—
21592
BCBS
FL
01
—
22031
BCBS
FL
01
—
CH5346
LICENSE#
FL
01
—
CH8350
LICENSE
FL
01
—
CH8937
LICENSE#
FL
01
—
CH9181
LICENSE NUMBER
FL
01
—
ME23061
LICENSE#
FL
01
—
PT9405
LICENSE#
FL
Enumeration date
07/27/2006
Last updated
08/16/2010
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