Healthcare Provider Details

I. General information

NPI: 1396625455
Provider Name (Legal Business Name): ROYAL PALM ORTHOPEDICS SPORTS MEDICINE AND INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CARLTON AVE STE 1400
LAKE WALES FL
33853-4347
US

IV. Provider business mailing address

1120 CARLTON AVE STE 1400
LAKE WALES FL
33853-4347
US

V. Phone/Fax

Practice location:
  • Phone: 863-324-6100
  • Fax: 863-324-6111
Mailing address:
  • Phone: 863-324-6100
  • Fax: 863-324-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: BENITO TORRES
Title or Position: PHYSICIAN
Credential: DO
Phone: 863-324-6100