Provider Demographics
NPI:1700215183
Name:DIRECT PT PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:DIRECT PT PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, GCS
Authorized Official - Phone:561-357-0231
Mailing Address - Street 1:7744 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7109
Mailing Address - Country:US
Mailing Address - Phone:561-357-0231
Mailing Address - Fax:
Practice Address - Street 1:7744 GREAT OAK DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7109
Practice Address - Country:US
Practice Address - Phone:561-357-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health