MEDICARE: JACOLBY WELLNESS INSTITUTE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1053326926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOLBY WELLNESS INSTITUTE INC

Provider Business Mailing Address
First Line	:	14708 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4041
Country	:	US
Telephone Number	:	305-553-3254
Fax Number	:	800-957-8356

Provider Business Practice Location Address
First Line	:	14708 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4041
Country	:	US
Telephone Number	:	305-553-3254
Fax Number	:	800-957-8356

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. OFELIA L CARDENAS
Credential	:	PT
Telephone Number	:	305-553-3254

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/08/2013

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