Provider Demographics
NPI:1831642859
Name:MASSABESIC HEALTH RESOURCES, VI, PC
Entity Type:Organization
Organization Name:MASSABESIC HEALTH RESOURCES, VI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:LESELE
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:340-643-4287
Mailing Address - Street 1:127 ESTATE SMITHFIELD
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:U.S. VIRGIN ISLANDS
Mailing Address - Zip Code:00840
Mailing Address - Country:UM
Mailing Address - Phone:340-643-4287
Mailing Address - Fax:340-772-1757
Practice Address - Street 1:127 ESTATE SMITHFIELD
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:U.S. VIRGIN ISLANDS
Practice Address - Zip Code:00840
Practice Address - Country:UM
Practice Address - Phone:340-643-4287
Practice Address - Fax:340-772-1757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI88261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy