Healthcare Provider Details

I. General information

NPI: 1114834405
Provider Name (Legal Business Name): RACE ELIE BOURGEOIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8983 OKEECHOBEE BLVD STE 208
WEST PALM BEACH FL
33411-5145
US

IV. Provider business mailing address

3811 TURTLE CREEK BLVD STE 850
DALLAS TX
75219-4560
US

V. Phone/Fax

Practice location:
  • Phone: 561-478-3702
  • Fax:
Mailing address:
  • Phone: 469-694-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number354009
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: