Basic Information
| Provider Information | |||||||||
| NPI: | 1558763979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELL | ||||||||
| FirstName: | JERMAINE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3848 FAU BLVD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952920 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 CORPORATE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334266600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547337677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT29698 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.