Healthcare Provider Details

I. General information

NPI: 1689044687
Provider Name (Legal Business Name): PALM BEACH ATLANTIC UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S FLAGER DR
WEST PALM BEACH FL
33401-6505
US

IV. Provider business mailing address

901 S FLAGER DR
WEST PALM BEACH FL
33401-6505
US

V. Phone/Fax

Practice location:
  • Phone: 561-803-2338
  • Fax: 561-370-7048
Mailing address:
  • Phone: 561-803-2338
  • Fax: 561-370-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE MENARD III
Title or Position: ATHLETIC TRAINING ADMINISTRATOR
Credential: DHSC, LAT, ATC
Phone: 561-803-2338