=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174373898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALCHEMIST PM&R LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2024
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E SAMPLE RD FL 4
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-456-6005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ROYAL PALM WAY APT 304
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-8735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-673-9850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MINH QUAN LE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 954-673-9850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------