Basic Information
Provider Information
NPI: 1518599877
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAROHL
FirstName: ERIC
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13020 N TELECOM PKWY
Address2:  
City: TEMPLE TERRACE
State: FL
PostalCode: 336370915
CountryCode: US
TelephoneNumber: 8139789700
FaxNumber: 8135586054
Practice Location
Address1: 909 N DALE MABRY HWY
Address2:  
City: TAMPA
State: FL
PostalCode: 336091251
CountryCode: US
TelephoneNumber: 8139789700
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/05/2020
LastUpdateDate: 03/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251G0304X14903-24WIN Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
2251X0800XPT35572FLY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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