Provider Demographics
NPI:1497102016
Name:BARWISMETHODS OF PORT ST LUCIE
Entity Type:Organization
Organization Name:BARWISMETHODS OF PORT ST LUCIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAT DIRECTOR OF INJURY RECOVERY
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:248-921-2282
Mailing Address - Street 1:525 NW PEACOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2210
Mailing Address - Country:US
Mailing Address - Phone:772-871-2123
Mailing Address - Fax:
Practice Address - Street 1:525 NW PEACOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2210
Practice Address - Country:US
Practice Address - Phone:772-871-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation