Healthcare Provider Details

I. General information

NPI: 1326799321
Provider Name (Legal Business Name): ROYAL PALM BEACH REHAB CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MONUMENT AVE
KISSIMMEE FL
34741-5762
US

IV. Provider business mailing address

4971 LE CHALET BLVD STE 100
BOYNTON BEACH FL
33436-1418
US

V. Phone/Fax

Practice location:
  • Phone: 321-262-0261
  • Fax: 321-262-0388
Mailing address:
  • Phone: 561-733-5590
  • Fax: 561-740-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROYAL PALM BEACH REHAB CORP
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 561-537-4526