Healthcare Provider Details

I. General information

NPI: 1043454572
Provider Name (Legal Business Name): FITNESS & WELLNESS WORKS FOR YOU, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 N. UNIVERSITY DRIVE SUITE 219
CORAL SPINGS FL
33071
US

IV. Provider business mailing address

934 N UNIVERSITY DR SUITE 219
CORAL SPRINGS FL
33071-7029
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-1690
  • Fax:
Mailing address:
  • Phone: 954-227-1690
  • Fax: 954-344-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL CANELO
Title or Position: CEO
Credential:
Phone: 954-227-1690