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General NPI Number Information
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NPI Number | 1972865103
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Entity Type | Organization
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Legal Business Name | ATLANTIC MEDICAL ALLIANCE
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 2925 10TH AVE N SUITE # 302
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City | PALM SPRINGS
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State | FL
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Zip | 33461-3000
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Country | US
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Telephone | 561-847-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 10TH AVE N SUITE # 302
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City | PALM SPRINGS
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State | FL
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Zip | 33461-3000
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Country | US
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Telephone | 561-847-4871
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANNY JACOMINO
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Credential |
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Telephone | 561-847-4871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA46172
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License Number State | FL
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