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General NPI Number Information
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NPI Number | 1609278704
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Entity Type | Organization
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Legal Business Name | PINE CREST SCHOOL
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 1501 NE 62ND ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33334-5116
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Country | US
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Telephone | 954-776-2134
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Fax | 954-492-4562
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Provider Business Mailing Address
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Address Line | 1501 NE 62ND ST
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City | FT LAUDERDALE
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State | FL
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Zip | 33334-5116
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Country | US
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Telephone | 954-776-2134
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Fax | 954-492-4562
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Authorized Official
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Title or Position | ATHLETIC DIRECTOR
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Name | MR. JEFF JOHNSON
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Credential |
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Telephone | 954-776-2134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number | AL1707
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License Number State | FL
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