MEDICARE: PALM BEACH REHABILITATION CLINIC

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	261QH0100X	Health Service Clinic/Center	ME56218	FL

General Provider Information

NPI Number	:	1952705568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH REHABILITATION CLINIC

Provider Business Mailing Address
First Line	:	6586 HYPOLUXO RD
Second Line	:	STE 306
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	561-386-3485
Fax Number	:	305-504-2737

Provider Business Practice Location Address
First Line	:	6586 HYPOLUXO RD
Second Line	:	STE 306
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	561-386-3485
Fax Number	:	305-504-2737

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. NESTOR FERNANDEZ
Credential	:	M.D.
Telephone Number	:	561-386-3485

Provider Enumeration Date	:	10/13/2014
Last Update Date	:	10/27/2014

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