Healthcare Provider Details

I. General information

NPI: 1740055060
Provider Name (Legal Business Name): HEALTH PROFESSIONAL CONNECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 W SAMPLE RD
CORAL SPRINGS FL
33065-3937
US

IV. Provider business mailing address

10101 W SAMPLE RD
CORAL SPRINGS FL
33065-3937
US

V. Phone/Fax

Practice location:
  • Phone: 954-686-7321
  • Fax:
Mailing address:
  • Phone: 954-686-7321
  • 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
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KASHAWN NELSON FRASER
Title or Position: CEO
Credential:
Phone: 561-635-7819