Healthcare Provider Details

I. General information

NPI: 1225465818
Provider Name (Legal Business Name): NEW LIFE PHYSICAL & MASSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SW 1ST ST
BELLE GLADE FL
33430-3469
US

IV. Provider business mailing address

1905 W BAKER ST SUITE B
PLANT CITY FL
33563-1601
US

V. Phone/Fax

Practice location:
  • Phone: 561-983-8671
  • Fax: 561-983-8901
Mailing address:
  • Phone: 813-704-6857
  • Fax: 561-282-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABIOLA ADEYEMO
Title or Position: PRESIDENT
Credential:
Phone: 813-679-0133