Healthcare Provider Details

I. General information

NPI: 1225143738
Provider Name (Legal Business Name): WELL BODY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 8TH AVE W
BRADENTON FL
34205-1701
US

IV. Provider business mailing address

3915 8TH AVE W
BRADENTON FL
34205-1701
US

V. Phone/Fax

Practice location:
  • Phone: 941-747-7741
  • Fax: 941-747-1431
Mailing address:
  • Phone: 941-747-7741
  • Fax: 941-747-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH W LABRECQUE
Title or Position: OWNER
Credential: PT
Phone: 941-747-7741