Provider Demographics
NPI:1164705729
Name:THERAPEUTIC SERVICES OF THE PALM BEA
Entity Type:Organization
Organization Name:THERAPEUTIC SERVICES OF THE PALM BEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-296-5288
Mailing Address - Street 1:2200 NORTH FLORIDA MANGO ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6464
Mailing Address - Country:US
Mailing Address - Phone:561-296-5288
Mailing Address - Fax:561-296-5287
Practice Address - Street 1:2200 NORTH FLORIDA MANGO ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6464
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-296-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty