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General NPI Number Information
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NPI Number | 1659862944
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Entity Type | Organization
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Legal Business Name | CONCIERGE PHYSICAL THERAPY OF PALM BEACH, INC
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Dates
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Enumeration Date | 05/23/2018
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Last Update Date | 05/23/2018
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Provider Practice Location Address
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Address Line | 3350 NW BOCA RATON BLVD STE A24
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City | BOCA RATON
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State | FL
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Zip | 33431-6609
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Country | US
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Telephone | 561-289-5186
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Fax | 561-430-3616
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Provider Business Mailing Address
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Address Line | 5475 ENCLAVE CROSSING WAY APT T1
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8198
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Country | US
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Telephone | 561-289-5186
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Fax | 561-430-3616
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLENN WOGALTER
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Credential | DPT
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Telephone | 561-289-5186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT25778
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License Number State | FL
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