=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619166030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD VIBRATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2007
-----------------------------------------------------
Last Update Date | 10/22/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4104 N 50TH AVE
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-963-7273
-----------------------------------------------------
Fax | 954-964-6397
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4104 N 50TH AVE.
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33021-1617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-963-7273
-----------------------------------------------------
Fax | 954-964-6397
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. RICHARD D KOENIG
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 954-963-7273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------