Healthcare Provider Details

I. General information

NPI: 1801101670
Provider Name (Legal Business Name): 1 ADVANCED REHAB & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 PROSPERITY FARMS RD STE 208
PALM BEACH GARDENS FL
33410-3446
US

IV. Provider business mailing address

11211 PROSPERITY FARMS RD STE 208
PALM BEACH GARDENS FL
33410-3446
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-5952
  • Fax:
Mailing address:
  • Phone: 561-296-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH3519
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: HENRY FERNANDEZ
Title or Position: MANAGER
Credential:
Phone: 561-398-8024