=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750972428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PANACEA THERAPY CO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2021
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8232 MASSACHUSETTS AVE
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-457-3168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8232 MASSACHUSETTS AVE
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-457-3168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | APRIL WESTBROOK
-----------------------------------------------------
Credential | COTA/L
-----------------------------------------------------
Telephone | 727-457-3168
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------