Provider Demographics
NPI:1790738052
Name:HARBOR PT & MASSAGE
Entity Type:Organization
Organization Name:HARBOR PT & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-697-2521
Mailing Address - Street 1:110 CENTURY BLVD
Mailing Address - Street 2:2ND FLR
Mailing Address - City:W. PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2262
Mailing Address - Country:US
Mailing Address - Phone:561-697-2521
Mailing Address - Fax:561-684-1919
Practice Address - Street 1:110 CENTURY BLVD
Practice Address - Street 2:2ND FLR
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-2262
Practice Address - Country:US
Practice Address - Phone:561-697-2521
Practice Address - Fax:561-684-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686617Medicare ID - Type Unspecified