=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679810071
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE RECOVERY TEAM, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2013
-----------------------------------------------------
Last Update Date | 01/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 NORTHLAKE BLVD SUITE 11
-----------------------------------------------------
City | NORTH PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33408-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-678-0078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 NORTHLAKE BLVD SUITE 11
-----------------------------------------------------
City | NORTH PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33408-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. FRED PETTERSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-678-0078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------