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General NPI Number Information
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NPI Number | 1245774322
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Entity Type | Organization
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Legal Business Name | GTD MEDICAL & REHABILITATION CENTER, INC
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Dates
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Enumeration Date | 12/08/2016
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Last Update Date | 12/08/2016
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Provider Practice Location Address
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Address Line | 1195 N MILITARY TRL STE 5B
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6058
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Country | US
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Telephone | 561-557-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 N MILITARY TRL STE 5B
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6058
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Country | US
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Telephone | 561-557-2138
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Fax |
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Authorized Official
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Title or Position | V PRESIDENT
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Name | DR. KESNEL THEUS
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Credential | D,O,M
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Telephone | 561-557-2138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2382
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME43064
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 2293
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License Number State | FL
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