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NPI Code Detail

MEDICARE: VIBRO AT LAKE WORTH LLC

MEDICARE: VIBRO AT LAKE WORTH LLC
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
12084A0401XAddiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number : 1639516743
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIBRO AT LAKE WORTH LLC
Provider Business Mailing Address
First Line : PO BOX 7240
Second Line :
City : JUPITER
State : FL
Zip : 33468-7240
Country : US
Telephone Number : 561-748-2889
Fax Number : 561-748-1523
Provider Business Practice Location Address
First Line : 3185 BOUTWELL RD
Second Line :
City : LAKE WORTH
State : FL
Zip : 33461-2610
Country : US
Telephone Number : 561-533-0074
Fax Number :
Authorized Official
Title or Position : PRESIDENT, JUPITER PROF DEVELOPMENT
Name : KAREN BARLOW
Credential :
Telephone Number : 561-748-2889
Provider Enumeration Date : 05/30/2013
Last Update Date : 05/30/2013

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Directions to “VIBRO AT LAKE WORTH LLC ” Practice Location

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