Healthcare Provider Details

I. General information

NPI: 1427325083
Provider Name (Legal Business Name): RECOVERY FIRST MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 W MIDWAY RD
FORT PIERCE FL
34981-4960
US

IV. Provider business mailing address

2223 SE MONTROSE LN
PORT ST LUCIE FL
34952-6065
US

V. Phone/Fax

Practice location:
  • Phone: 772-460-2777
  • Fax:
Mailing address:
  • Phone: 800-990-0340
  • Fax: 877-568-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNY ZAYAS
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 800-990-0340