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General NPI Number Information
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NPI Number | 1205364692
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Entity Type | Organization
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Legal Business Name | PALM BEACH THERAPY & FITNESS PROVIDERS, INC.
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 6525 BELLAGGIO LAKES BLVD
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City | LAKE WORTH
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State | FL
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Zip | 33467-6165
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Country | US
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Telephone | 561-676-1041
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Fax | 561-370-7034
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Provider Business Mailing Address
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Address Line | 15682 CYPRESS PARK DR
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City | WELLINGTON
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State | FL
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Zip | 33414-6356
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Country | US
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Telephone | 561-676-1041
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Fax | 561-370-7034
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHLEEN M RIOLINO
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Credential |
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Telephone | 561-676-1041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 21985
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License Number State | FL
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