Provider Demographics
NPI:1689044687
Name:PALM BEACH ATLANTIC UNIVERSITY
Entity type:Organization
Organization Name:PALM BEACH ATLANTIC UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:III
Authorized Official - Credentials:DHSC LAT
Authorized Official - Phone:561-803-2338
Mailing Address - Street 1:901 S FLAGER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6505
Mailing Address - Country:US
Mailing Address - Phone:561-803-2338
Mailing Address - Fax:561-803-2532
Practice Address - Street 1:901 S FLAGER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6505
Practice Address - Country:US
Practice Address - Phone:561-803-2338
Practice Address - Fax:561-803-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty