Provider Demographics
NPI:1487828844
Name:PROTHERAPY HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:PROTHERAPY HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-416-2529
Mailing Address - Street 1:6018 SW 18TH ST
Mailing Address - Street 2:SUITE C10
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7199
Mailing Address - Country:US
Mailing Address - Phone:561-416-2529
Mailing Address - Fax:
Practice Address - Street 1:6018 SW 18TH ST
Practice Address - Street 2:SUITE C10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7199
Practice Address - Country:US
Practice Address - Phone:561-416-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM19672225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty