Provider Demographics
NPI:1467107193
Name:ADVANCED PHYSICAL MEDICINE & REHAB OF JUPITER LLC
Entity Type:Organization
Organization Name:ADVANCED PHYSICAL MEDICINE & REHAB OF JUPITER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:GAMBARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:305-815-1238
Mailing Address - Street 1:175 TONEY PENNA DR STE 102
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 TONEY PENNA DR STE 102
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5747
Practice Address - Country:US
Practice Address - Phone:305-598-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty