Provider Demographics
NPI:1619298544
Name:PSG OF NAPLES LLC
Entity Type:Organization
Organization Name:PSG OF NAPLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-368-7118
Mailing Address - Street 1:40 SE 5TH ST STE 406
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-6003
Mailing Address - Country:US
Mailing Address - Phone:561-368-7118
Mailing Address - Fax:561-368-7116
Practice Address - Street 1:40 SE 5TH ST STE 406
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6003
Practice Address - Country:US
Practice Address - Phone:561-368-7118
Practice Address - Fax:561-368-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0071832081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty