Healthcare Provider Details

I. General information

NPI: 1063787539
Provider Name (Legal Business Name): SOUTH FLORIDA NEUROPATHY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2012
Last Update Date: 03/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-3490
US

IV. Provider business mailing address

3233 SW PORT ST LUCIE BLVD
PORT ST LUCIE FL
34953-3490
US

V. Phone/Fax

Practice location:
  • Phone: 772-873-5552
  • Fax: 772-873-5747
Mailing address:
  • Phone: 772-873-5552
  • Fax: 772-873-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES FAULHABER
Title or Position: OWNER/PESIDENT
Credential: DC
Phone: 772-873-5552