Provider Demographics
NPI:1952705568
Name:PALM BEACH REHABILITATION CLINIC
Entity Type:Organization
Organization Name:PALM BEACH REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-386-3485
Mailing Address - Street 1:6586 HYPOLUXO RD
Mailing Address - Street 2:STE 306
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:561-386-3485
Mailing Address - Fax:305-504-2737
Practice Address - Street 1:6586 HYPOLUXO RD
Practice Address - Street 2:STE 306
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7678
Practice Address - Country:US
Practice Address - Phone:561-386-3485
Practice Address - Fax:305-504-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56218261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service