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General NPI Number Information
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NPI Number | 1821339953
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Entity Type | Organization
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Legal Business Name | WEST PALM MEDICAL SPA
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Dates
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Enumeration Date | 03/14/2013
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 6383 10TH AVE N STE C
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City | GREENACRES
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State | FL
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Zip | 33463-1689
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Country | US
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Telephone | 561-460-3058
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Fax |
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Provider Business Mailing Address
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Address Line | 6383 10TH AVE N STE C
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City | GREENACRES
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State | FL
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Zip | 33463
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Country | US
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Telephone | 561-460-3058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALEXANDER JUSTO
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Credential | MD
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Telephone | 561-460-3058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MA70551
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License Number State | FL
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