Provider Demographics
NPI:1659461887
Name:ROYAL PALM BEACH MEDICAL INC
Entity Type:Organization
Organization Name:ROYAL PALM BEACH MEDICAL INC
Other - Org Name:PHYSICAL THERAPY INSTITUTE OF SOUTH FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-801-2535
Mailing Address - Street 1:106 PONCE DE LEON STREET
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1213
Mailing Address - Country:US
Mailing Address - Phone:561-791-9090
Mailing Address - Fax:561-791-9071
Practice Address - Street 1:106 PONCE DE LEON STREET
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1213
Practice Address - Country:US
Practice Address - Phone:561-791-9090
Practice Address - Fax:561-791-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381729600Medicaid
FL381729600Medicaid