| Organization Name: | TREASURE COAST PHYSICAL MEDICINE, LLC |
| NPI Number: | 1205271699 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBEKAH LEAH CAMPBELL (OWNER) |
| Mailing Address: | 529 Se Palm Beach Rd Suite 102 Stuart |
| State: | FL US |
| Postal Code: | 349942477 |
| Phone Number: | 7727814044 |
| Fax Number: | |
| NPI Enumeration Date: | 04/30/2013 |
| NPI Last Update Date: | 06/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS 5435 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |