Healthcare Provider Details

I. General information

NPI: 1659297810
Provider Name (Legal Business Name): ADVANCED EMG SPORTS & SPINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S AUSTRALIAN AVE STE 1010
WEST PALM BEACH FL
33401-6220
US

IV. Provider business mailing address

14427 SPRUCE PINE DR
WESTLAKE FL
33470-2037
US

V. Phone/Fax

Practice location:
  • Phone: 561-905-7290
  • Fax: 334-926-5613
Mailing address:
  • Phone: 561-568-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO GARCIA-LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 561-905-7290