Healthcare Provider Details

I. General information

NPI: 1518419092
Provider Name (Legal Business Name): ROYAL PALM BEACH REHAB, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100470 OVERSEAS HWY
KEY LARGO FL
33037-2548
US

IV. Provider business mailing address

3345 BURNS RD SUITE 202
PALM BEACH GARDENS FL
33410-4324
US

V. Phone/Fax

Practice location:
  • Phone: 561-588-9912
  • Fax: 561-828-2908
Mailing address:
  • Phone: 561-588-9912
  • Fax: 561-828-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN PAPA
Title or Position: CEO
Credential: DC
Phone: 561-801-2535