Healthcare Provider Details

I. General information

NPI: 1487789673
Provider Name (Legal Business Name): MYOTHERAPY-MASSAGE GROUP OF PALM BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 NORTH MILITARY TRAIL SUITE D
PALM BCH GRDNS FL
33410
US

IV. Provider business mailing address

8295 N MILITARY TRL SUITE D
WEST PALM BEACH FL
33410-6312
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-0410
  • Fax: 561-630-0699
Mailing address:
  • Phone: 561-630-0410
  • Fax: 561-630-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMA0008727
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN CHARLES PAPENDICK SR.
Title or Position: PRESIDENT
Credential: CTPM, LMT
Phone: 561-630-0410