MEDICARE: MYOTHERAPY-MASSAGE GROUP OF PALM BEACH, INC.

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	261QM2500X	Medical Specialty Clinic/Center	MA0008727	FL

General Provider Information

NPI Number	:	1487789673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYOTHERAPY-MASSAGE GROUP OF PALM BEACH, INC.

Provider Business Mailing Address
First Line	:	8295 N MILITARY TRL
Second Line	:	SUITE D
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33410-6312
Country	:	US
Telephone Number	:	561-630-0410
Fax Number	:	561-630-0699

Provider Business Practice Location Address
First Line	:	8295 NORTH MILITARY TRAIL
Second Line	:	SUITE D
City	:	PALM BCH GRDNS
State	:	FL
Zip	:	33410
Country	:	US
Telephone Number	:	561-630-0410
Fax Number	:	561-630-0699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN CHARLES PAPENDICK SR.
Credential	:	CTPM, LMT
Telephone Number	:	561-630-0410

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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