MEDICARE: THE RECOVERY TEAM, 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1679810071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RECOVERY TEAM, INC

Provider Business Mailing Address
First Line	:	450 NORTHLAKE BLVD
Second Line	:	SUITE 11
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5415
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 NORTHLAKE BLVD
Second Line	:	SUITE 11
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5415
Country	:	US
Telephone Number	:	954-678-0078
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. FRED PETTERSEN
Credential	:
Telephone Number	:	954-678-0078

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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