# ST JUDE PROFESSIONAL CARE INC

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

## Provider details

- **NPI number:** 1558743666
- **Authorized official:** NICOLE NICODEMO PT (OWNER)
- **Authorized official phone:** (786) 663-6394

## Contact information

- **Practice address:** 9806 PINES BLVD, PEMBROKE PINES, FL 33024-6141
- **Practice address phone:** (786) 663-6394
- **Practice address fax:** (954) 367-5246
- **Mailing address:** 9806 PINES BLVD, PEMBROKE PINES, FL 33024-6141
- **Mailing address phone:** (786) 663-6394
- **Mailing address fax:** (954) 367-5246

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | PT25877 | FL | Yes |

## Other

- **Enumeration date:** 06/25/2015
- **Last updated:** 02/18/2016