MEDICARE: WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) 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	174400000X	Specialist

General Provider Information

NPI Number	:	1548859192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) INC.

Provider Business Mailing Address
First Line	:	3380 N TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-8221
Country	:	US
Telephone Number	:	321-412-8057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 PERKINSON LN MERRITT ISLAND FL 32953
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3295
Country	:	US
Telephone Number	:	321-412-8057
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	PATRICIA BRYAN
Credential	:	MS HEALTH AND HUMAN
Telephone Number	:	321-412-8057

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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