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General NPI Number Information
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NPI Number | 1336654763
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Entity Type | Organization
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Legal Business Name | PHYSICIANS GROUP OF THE TREASURE COAST LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1131 SE INDIAN ST
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City | STUART
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State | FL
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Zip | 34997-5765
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Country | US
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Telephone | 772-617-0124
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Fax | 772-223-5110
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Provider Business Mailing Address
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Address Line | 1131 SE INDIAN ST
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City | STUART
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State | FL
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Zip | 34997-5765
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Country | US
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Telephone | 772-617-0124
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Fax | 772-223-5110
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA TUCKER
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Credential |
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Telephone | 772-219-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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