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General NPI Number Information
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NPI Number | 1780314559
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Entity Type | Organization
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Legal Business Name | UNITED THERA GROUP LLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 2450 LANTANA RD APT 2311
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City | LAKE WORTH
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State | FL
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Zip | 33462-0930
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Country | US
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Telephone | 954-283-9977
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Fax | 727-416-6921
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Provider Business Mailing Address
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Address Line | 2450 LANTANA RD APT 2311
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City | LAKE WORTH
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State | FL
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Zip | 33462-0930
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Country | US
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Telephone | 954-283-9977
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Fax | 727-416-6921
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Authorized Official
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Title or Position | MANAGER
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Name | JEAN JONAS AUGUSTE
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Credential | PTA
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Telephone | 561-891-5558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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