| Organization Name: | ST JUDE PROFESSIONAL CARE INC |
| NPI Number: | 1780959270 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NICOLE NICODEMO (OWNER) |
| Mailing Address: | 900 Sw 142nd Ave Suffolk L 114 Pembroke Pines |
| State: | FL US |
| Postal Code: | 330273573 |
| Phone Number: | 7866636394 |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2012 |
| NPI Last Update Date: | 03/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 25877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |