Organization
ADVANCED CLINICAL & ORTHOPEDIC MASSAGE INC
Active
Other names
The Injury Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIMON W BRISCOE LMT, NCMMT (PRESIDENT/CEO)
(561) 684-1169
Entity
Organization
Contact information
Practice address
2930 OKEECHOBEE BLVD, SUITE 108, WEST PALM BEACH, FL 33409-4037
(561) 684-1169
(561) 684-6112
Mailing address
537 GOLDENWOOD WAY, WELLINGTON, FL 33414-4966
(561) 798-3564
(561) 798-3564
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA29117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4052
BCBS OF FLORIDA ID #
FL
Enumeration date
11/01/2006
Last updated
06/16/2008
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