Provider Demographics
NPI:1801223730
Name:PALM BEACH PHYSICAL MEDICINE AND REHABILITATION,LLC
Entity Type:Organization
Organization Name:PALM BEACH PHYSICAL MEDICINE AND REHABILITATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-716-4110
Mailing Address - Street 1:1926 10TH AVE N STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3300
Mailing Address - Country:US
Mailing Address - Phone:561-582-5634
Mailing Address - Fax:561-582-5635
Practice Address - Street 1:1926 10TH AVE N STE 104
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3300
Practice Address - Country:US
Practice Address - Phone:561-582-5634
Practice Address - Fax:561-582-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty