# DANIEL ETTEDGUI, D.O. PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Physical Medicine of South Florida
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265516611
- **Authorized official:** MRS. FLORI F MCGINTY (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (561) 912-9580

## Contact information

- **Practice address:** 1905 CLINT MOORE ROAD, SUITE 308, BOCA RATON, FL 33496-2658
- **Practice address phone:** (561) 912-9580
- **Practice address fax:** (561) 912-9506
- **Mailing address:** 1905 CLINT MOORE ROAD, SUITE 308, BOCA RATON, FL 33496
- **Mailing address phone:** (561) 912-9580
- **Mailing address fax:** (561) 912-9506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | OS-6221 | FL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | OS6221 | FL | — |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 04/13/2012