Healthcare Provider Details

I. General information

NPI: 1366784688
Provider Name (Legal Business Name): LIBERTY OF WEST PALM BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CENTRAL GARDENS CIR
PALM BEACH GARDENS FL
33418-8700
US

IV. Provider business mailing address

1601 BELVEDERE RD STE 407S
WEST PALM BEACH FL
33406-1518
US

V. Phone/Fax

Practice location:
  • Phone: 561-644-4186
  • Fax: 561-536-5528
Mailing address:
  • Phone: 561-644-4186
  • Fax: 616-607-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA FITOS
Title or Position: REHAB DIRECTOR
Credential: PTA
Phone: 561-644-4186