Provider Demographics
NPI:1659862944
Name:CONCIERGE PHYSICAL THERAPY OF PALM BEACH, INC
Entity Type:Organization
Organization Name:CONCIERGE PHYSICAL THERAPY OF PALM BEACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOGALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-289-5186
Mailing Address - Street 1:5475 ENCLAVE CROSSING WAY APT T1
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8198
Mailing Address - Country:US
Mailing Address - Phone:561-289-5186
Mailing Address - Fax:561-430-3616
Practice Address - Street 1:3350 NW BOCA RATON BLVD STE A24
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6609
Practice Address - Country:US
Practice Address - Phone:561-289-5186
Practice Address - Fax:561-430-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25778225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty