Provider Demographics
NPI:1366786931
Name:PALM ORTHOPEDICS AND REHABILITATION, LLC
Entity type:Organization
Organization Name:PALM ORTHOPEDICS AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VANDERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-961-5699
Mailing Address - Street 1:5458 TOWN CENTER RD
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-961-5699
Mailing Address - Fax:561-961-5899
Practice Address - Street 1:5458 TOWN CENTER ROAD
Practice Address - Street 2:SUITE 104B
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-961-5699
Practice Address - Fax:561-961-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty