Provider Demographics
NPI:1639404072
Name:ABP AVENTURA
Entity Type:Organization
Organization Name:ABP AVENTURA
Other - Org Name:RELAX THE BACK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-417-4404
Mailing Address - Street 1:2200 GLADES RD
Mailing Address - Street 2:STE 101A
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7309
Mailing Address - Country:US
Mailing Address - Phone:561-417-4404
Mailing Address - Fax:305-629-9312
Practice Address - Street 1:2200 GLADES RD
Practice Address - Street 2:STE 101A
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7309
Practice Address - Country:US
Practice Address - Phone:561-417-4404
Practice Address - Fax:305-629-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60-8012925338-9332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment