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General NPI Number Information
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NPI Number | 1801138375
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Entity Type | Organization
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Legal Business Name | ABUNDANCE SPA AND REHAB, INC
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 3650 SW 10TH ST 1-B
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-5997
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Country | US
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Telephone | 954-857-2900
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Fax | 954-857-2901
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Provider Business Mailing Address
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Address Line | 3650 SW 10TH ST 1-B
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-5997
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Country | US
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Telephone | 954-857-2900
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Fax | 954-857-2901
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. RAPHAEL CERVERA
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Credential | D.O
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Telephone | 954-857-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 9589
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License Number State | FL
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