Healthcare Provider Details

I. General information

NPI: 1639764962
Provider Name (Legal Business Name): PALM BEACH PHYSICAL THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 S CONGRESS AVE
BOYNTON BEACH FL
33426-9045
US

IV. Provider business mailing address

1981 SW AARON LN
PORT ST LUCIE FL
34953-2127
US

V. Phone/Fax

Practice location:
  • Phone: 772-342-3834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUDY JACKSON
Title or Position: DIRECTOR
Credential:
Phone: 772-342-3834