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Organization
SPINAL THERAPY MEDICAL GROUP FL
Active
Organization
SPINAL THERAPY MEDICAL GROUP FL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI WEISER PTA (PRESIDENT)
(561) 237-1717
Entity
Organization
Contact information
Practice address
433 PLAZA REAL, SUITE 255, BOCA RATON, FL 33432-3932
(561) 237-1717
(561) 237-1725
Mailing address
433 PLAZA REAL, SUITE 255, BOCA RATON, FL 33432-3932
(561) 237-1717
(561) 237-1725
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
ME51866
FL
225100000X
Physical Therapist
Primary
PTA17624
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME51866
LICENSE
FL
01
—
PT21956
LICENSE
FL
01
—
PTA17624
LICENSE
FL
Enumeration date
07/12/2007
Last updated
07/23/2007
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