MEDICARE: NEXT WELLNESS LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1235796590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXT WELLNESS LLC

Provider Business Mailing Address
First Line	:	3555 SW CORPORATE PKWY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8152
Country	:	US
Telephone Number	:	215-584-3828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3555 SW CORPORATE PKWY
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8152
Country	:	US
Telephone Number	:	215-584-3828
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MANAGER
Name	:	TIFFANY WAI LOC
Credential	:	DC
Telephone Number	:	215-584-3828

Provider Enumeration Date	:	05/22/2019
Last Update Date	:	05/22/2019

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Directions to “NEXT WELLNESS LLC ” Practice Location

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