| Personalized And Restorative Wellness Pa | |
|
13005 Southern Blvd Ste 221 Loxahatchee FL 33470-9272 | |
| (561) 517-8678 | |
| (561) 529-5082 |
| Full Name | Personalized And Restorative Wellness Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 13005 Southern Blvd Ste 221, Loxahatchee, Florida |
| Authorized Official Name and Position | Michal Wall (CEO) |
| Authorized Official Contact | 5615178678 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Personalized And Restorative Wellness Pa 13005 Southern Blvd Ste 221 Loxahatchee FL 33470-9272 Ph: (561) 517-8678 | Personalized And Restorative Wellness Pa 13005 Southern Blvd Ste 221 Loxahatchee FL 33470-9272 Ph: (561) 517-8678 |
| NPI Number | 1710574413 |
|---|---|
| Provider Enumeration Date | 12/29/2020 |
| Last Update Date | 06/30/2026 |
| Medicare PECOS PAC ID | 1951710086 |
|---|---|
| Medicare Enrollment ID | O20210503000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710574413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Michal S Wall |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871701706 PECOS PAC ID: 2668633447 Enrollment ID: I20120423000546 |
| Provider Name | Itamar Wall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982243630 PECOS PAC ID: 2264831544 Enrollment ID: I20210519002231 |
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