45th St Pain Management LLC
Physical Medicine & Rehabilitation in West Palm Beach, FL. Organization (NPI-2).
NPI number1013383835
StatusActive
Last updated in NPPESAug 16, 2015
Details
- NPI
- 1013383835
- Entity type
- Organization (NPI-2)
- Legal business name
- 45th St Pain Management LLC
- Organization subpart
- No
- Enumeration date
- Aug 16, 2015
- Last updated
- Aug 16, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208100000X | Physical Medicine & Rehabilitation | me97529 | FL | Yes |
| 208VP0000X | ME97529 | FL |
Practice location
5642 Corporate WayWest Palm Beach, FL 33407-2002
Phone 561-469-2635 · Fax 561-469-2614
Mailing address
5642 Corporate WayWest Palm Beach, FL 33407-2002
Phone 561-469-2635 · Fax 561-469-2614
Authorized official
Gardy D Marcelin
Ceo
5614692635
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