Healthcare Provider Details

I. General information

NPI: 1801138375
Provider Name (Legal Business Name): ABUNDANCE SPA AND REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 SW 10TH ST 1-B
DEERFIELD BEACH FL
33442-5997
US

IV. Provider business mailing address

3650 SW 10TH ST 1-B
DEERFIELD BEACH FL
33442-5997
US

V. Phone/Fax

Practice location:
  • Phone: 954-857-2900
  • Fax: 954-857-2901
Mailing address:
  • Phone: 954-857-2900
  • Fax: 954-857-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number9589
License Number StateFL

VIII. Authorized Official

Name: DR. RAPHAEL CERVERA
Title or Position: CHIROPRACTOR
Credential: D.O
Phone: 954-857-2900