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NPI Code Detail

MEDICARE: PROFESSIONALS TRUST INC.

MEDICARE: PROFESSIONALS TRUST INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist4624FL

General Provider Information

NPI Number : 1750565925
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONALS TRUST INC.
Provider Business Mailing Address
First Line : 2650 W STATE ROAD 84
Second Line : L03
City : FORT LAUDERDALE
State : FL
Zip : 33312-4882
Country : US
Telephone Number : 954-327-0396
Fax Number : 954-327-0397
Provider Business Practice Location Address
First Line : 2650 W STATE ROAD 84
Second Line : L03
City : FORT LAUDERDALE
State : FL
Zip : 33312-4882
Country : US
Telephone Number : 954-327-0396
Fax Number : 954-327-0397
Authorized Official
Title or Position : DIRECTOR
Name : DR. JOHN ALBERT LA POINTE
Credential : PHD
Telephone Number : 954-327-0397
Provider Enumeration Date : 12/24/2007
Last Update Date : 12/24/2007

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Directions to “PROFESSIONALS TRUST INC. ” Practice Location

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