Healthcare Provider Details

I. General information

NPI: 1811358294
Provider Name (Legal Business Name): MILLAKE WELLNESS & PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 LAKE WORTH RD SUITE 203
GREENACRES FL
33463-3461
US

IV. Provider business mailing address

4849 LAKE WORTH RD SUITE 203
GREENACRES FL
33463-3461
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-4446
  • Fax: 561-433-3026
Mailing address:
  • Phone: 561-433-4446
  • Fax: 561-433-3026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberME0047706
License Number StateFL

VIII. Authorized Official

Name: DAVID ABELLARD
Title or Position: PHYSICIAN
Credential: MD
Phone: 561-433-4446