Healthcare Provider Details

I. General information

NPI: 1699410597
Provider Name (Legal Business Name): GOLD COAST PHYSICAL THERAPY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W INDIANTOWN RD STE 5
JUPITER FL
33458-7575
US

IV. Provider business mailing address

5840 CORPORATE WAY STE 101
WEST PALM BEACH FL
33407-2040
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-0111
  • Fax: 561-432-1075
Mailing address:
  • Phone: 156-143-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA CONOVER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 561-432-0111