# PB MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366812943
- **Authorized official:** COLIN DAVIS WALLACE MBR (CO-FOUNDER AND CEO)
- **Authorized official phone:** (561) 255-4135

## Contact information

- **Practice address:** 2290 10TH AVE N STE 201, LAKE WORTH, FL 33461-6609
- **Practice address phone:** (561) 225-2890
- **Mailing address:** 2290 10TH AVE N STE 201, LAKE WORTH, FL 33461-6609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 09/25/2015
- **Last updated:** 09/28/2015