Organization
COLUMNA
Active
Organization
COLUMNA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS ROUSH (OWNER)
(561) 531-2401
Entity
Organization
Contact information
Practice address
3618 LANTANA RD STE 201, LAKE WORTH, FL 33462-2247
(561) 296-2220
Mailing address
3618 LANTANA RD STE 201, LAKE WORTH, FL 33462-2247
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
ME105711
FL
Other
Enumeration date
11/03/2010
Last updated
11/03/2010
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