Provider Demographics
NPI:1710231501
Name:CORE WITHIN HEALING CENTER
Entity Type:Organization
Organization Name:CORE WITHIN HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPY
Authorized Official - Phone:561-371-3622
Mailing Address - Street 1:17380 ALT A1A
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5860
Mailing Address - Country:US
Mailing Address - Phone:561-371-3622
Mailing Address - Fax:
Practice Address - Street 1:17380 ALT A1A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5860
Practice Address - Country:US
Practice Address - Phone:561-371-3622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM29791261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service