Healthcare Provider Details

I. General information

NPI: 1356618185
Provider Name (Legal Business Name): WHOLESOME FAMILY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 NW 28TH WAY
BOCA RATON FL
33434-5819
US

IV. Provider business mailing address

4420 NW 28TH WAY
BOCA RATON FL
33434-5819
US

V. Phone/Fax

Practice location:
  • Phone: 561-577-4860
  • Fax: 561-509-7621
Mailing address:
  • Phone: 561-577-4860
  • Fax: 561-509-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25905
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA52832
License Number StateFL

VIII. Authorized Official

Name: ALEXANDER P SOAVE
Title or Position: OWNER
Credential: DPT, LMT
Phone: 561-577-4860