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General NPI Number Information
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NPI Number | 1497102016
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Entity Type | Organization
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Legal Business Name | BARWISMETHODS OF PORT ST LUCIE
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 525 NW PEACOCK BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2210
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Country | US
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Telephone | 772-871-2123
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Fax |
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Provider Business Mailing Address
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Address Line | 525 NW PEACOCK BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2210
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Country | US
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Telephone | 772-871-2123
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Fax |
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Authorized Official
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Title or Position | NAT DIRECTOR OF INJURY RECOVERY
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Name | DR. NICHOLAS LUCIUS
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Credential | PT, DPT, CSCS
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Telephone | 248-921-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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