Healthcare Provider Details

I. General information

NPI: 1598239642
Provider Name (Legal Business Name): HEROES WELLNESS FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STATE ROAD 436 STE 2080
CASSELBERRY FL
32707-5343
US

IV. Provider business mailing address

500 STATE ROAD 436 STE 2080
CASSELBERRY FL
32707-5343
US

V. Phone/Fax

Practice location:
  • Phone: 770-912-3234
  • Fax:
Mailing address:
  • Phone: 770-912-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALIREZA AFSHARI
Title or Position: OWNER
Credential: DC
Phone: 770-912-3234