Provider Demographics
NPI:1396117339
Name:CUTTING EDGE PHYSICAL THERAPY & WELLNESS
Entity type:Organization
Organization Name:CUTTING EDGE PHYSICAL THERAPY & WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE-DE FREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-619-8954
Mailing Address - Street 1:1717 N FLAGLER DR
Mailing Address - Street 2:STE #11
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-619-8954
Mailing Address - Fax:561-619-8954
Practice Address - Street 1:1717 N. FLAGLER DR.
Practice Address - Street 2:STE #11
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-619-8954
Practice Address - Fax:561-619-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty