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General NPI Number Information
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NPI Number | 1780900449
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Entity Type | Organization
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Legal Business Name | THEBAUT CONSULTING INC., DBA PALM BEACH HAND
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 1002 S OLD DIXIE HWY SUITE 105
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City | JUPITER
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State | FL
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Zip | 33458-7202
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Country | US
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Telephone | 561-743-4263
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Fax | 561-776-6111
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | JUPITER
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State | FL
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Zip | 33468-0011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, JUPITER PROFESSIONAL DEV
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Name | KAREN BARLOW
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Credential |
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Telephone | 561-748-2889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | ME0020057
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License Number State | FL
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