Healthcare Provider Details

I. General information

NPI: 1609059641
Provider Name (Legal Business Name): REGIONAL PHYSIOTHERAPY CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 OKEECHOBEE BLVD
WEST PALM BEACH FL
33417
US

IV. Provider business mailing address

5601 OKEECHOBEE BLVD SUITE B
WEST PALM BEACH FL
33417
US

V. Phone/Fax

Practice location:
  • Phone: 561-531-3046
  • Fax:
Mailing address:
  • Phone: 561-202-6488
  • Fax: 561-202-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT18042
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID LIGHT
Title or Position: PRESIDENT
Credential: PT
Phone: 561-202-6488