Provider Demographics
NPI:1821339953
Name:WEST PALM MEDICAL SPA
Entity Type:Organization
Organization Name:WEST PALM MEDICAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-460-3058
Mailing Address - Street 1:6383 10TH AVE N STE C
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463
Mailing Address - Country:US
Mailing Address - Phone:561-460-3058
Mailing Address - Fax:
Practice Address - Street 1:6383 10TH AVE N
Practice Address - Street 2:STE C
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-1689
Practice Address - Country:US
Practice Address - Phone:561-460-3058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA70551261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy