Healthcare Provider Details

I. General information

NPI: 1952845919
Provider Name (Legal Business Name): ESENCIA WELLNESS & THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S UNIVERSITY DR STE 101
DAVIE FL
33328-3835
US

IV. Provider business mailing address

4801 S UNIVERSITY DR STE 101
DAVIE FL
33328-3835
US

V. Phone/Fax

Practice location:
  • Phone: 954-316-1476
  • Fax: 954-316-1130
Mailing address:
  • Phone: 954-316-1476
  • Fax: 954-316-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LOURDES GODOMAR
Title or Position: OWNER
Credential:
Phone: 305-318-4439