Provider Demographics
NPI:1679914105
Name:PALM ORTHOPEDICS & PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:PALM ORTHOPEDICS & PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-345-3933
Mailing Address - Street 1:10521 SW VILLAGE CENTER DR STE 201A
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-1930
Mailing Address - Country:US
Mailing Address - Phone:772-345-2642
Mailing Address - Fax:
Practice Address - Street 1:10801 SW TRADITION SQ
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-1934
Practice Address - Country:US
Practice Address - Phone:772-345-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty