Organization
ST JUDE PROFESSIONAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE NICODEMO PT (OWNER)
(786) 663-6394
Entity
Organization
Contact information
Practice address
9806 PINES BLVD, PEMBROKE PINES, FL 33024-6141
(786) 663-6394
(954) 367-5246
Mailing address
9806 PINES BLVD, PEMBROKE PINES, FL 33024-6141
(786) 663-6394
(954) 367-5246
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT25877
FL
Other
Enumeration date
06/25/2015
Last updated
02/18/2016
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