MEDICARE: THERAPEUTIC SERVICES OF THE PALM BEA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1164705729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC SERVICES OF THE PALM BEA

Provider Business Mailing Address
First Line	:	2200 NORTH FLORIDA MANGO ROAD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6464
Country	:	US
Telephone Number	:	561-296-5288
Fax Number	:	561-296-5287

Provider Business Practice Location Address
First Line	:	2200 NORTH FLORIDA MANGO ROAD
Second Line	:	SUITE 201
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6464
Country	:	US
Telephone Number	:	561-296-5288
Fax Number	:	561-296-5287

Authorized Official
Title or Position	:	CEO & MEDICAL DIRECTOR
Name	:	DR. ROBERT ALLEN MORAN
Credential	:	M.D.
Telephone Number	:	561-296-5288

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	12/29/2011

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