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General NPI Number Information
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NPI Number | 1760503015
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Entity Type | Organization
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Legal Business Name | INJURY TREATMENT CENTER OF BOYNTON BEACH INC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1325 S CONGRESS AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-5876
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Country | US
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Telephone | 561-736-8060
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Fax | 561-736-0548
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Provider Business Mailing Address
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Address Line | 2295 NW CORPORATE BLVD SUITE 140
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City | BOCA RATON
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State | FL
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Zip | 33431-7373
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Country | US
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Telephone | 561-241-1971
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Fax | 561-241-3969
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Authorized Official
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Title or Position | CONSULTANT
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Name | EVAN SADE
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Credential |
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Telephone | 954-817-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | HCC3660
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License Number State | FL
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