Healthcare Provider Details

I. General information

NPI: 1508019860
Provider Name (Legal Business Name): ROYAL PALM BEACH MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 N UNIVERSITY DR SUITE 100
TAMARAC FL
33321-2902
US

IV. Provider business mailing address

106 PONCE DE LEON ST
ROYAL PALM BEACH FL
33411-1213
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-9090
  • Fax: 561-791-9071
Mailing address:
  • Phone: 561-791-9090
  • Fax: 561-791-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. ELAINE OSWALD
Title or Position: CREDENTIALING
Credential: R.N.
Phone: 561-624-2706