Provider Demographics
NPI:1902116049
Name:HYPERBARIC TREATMENT ASSOCIATION
Entity Type:Organization
Organization Name:HYPERBARIC TREATMENT ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:REILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-296-4094
Mailing Address - Street 1:129 SEAGROVE MAIN STREET
Mailing Address - Street 2:202
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080
Mailing Address - Country:US
Mailing Address - Phone:804-296-4094
Mailing Address - Fax:
Practice Address - Street 1:129 SEAGROVE MAIN STREET
Practice Address - Street 2:202
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6376
Practice Address - Country:US
Practice Address - Phone:804-296-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9303002261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1407050024OtherJOHN DELUCA, M.D., MEDICAL DIRECTOR, NPI