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General NPI Number Information
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NPI Number | 1558886069
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Entity Type | Organization
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Legal Business Name | RADIUS TBI OF SOUTH FLORIDA
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Dates
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Enumeration Date | 08/04/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4330 W BROWARD BLVD STE G
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City | PLANTATION
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State | FL
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Zip | 33317-3753
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Country | US
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Telephone | 954-598-0779
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Fax |
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Provider Business Mailing Address
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Address Line | 4330 W BROWARD BLVD STE G
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City | PLANTATION
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State | FL
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Zip | 33317-3753
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Country | US
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Telephone | 954-598-0779
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRIAN MEVORAH
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Credential | DC
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Telephone | 954-471-2133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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