Healthcare Provider Details

I. General information

NPI: 1265111496
Provider Name (Legal Business Name): DR. PHYSIO THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 S FEDERAL HWY STE 8
DELRAY BEACH FL
33483-3266
US

IV. Provider business mailing address

3205 S FEDERAL HWY STE 8
DELRAY BEACH FL
33483-3266
US

V. Phone/Fax

Practice location:
  • Phone: 954-369-5787
  • Fax: 954-206-7733
Mailing address:
  • Phone: 954-369-5787
  • Fax: 954-206-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LENISSON MELO CARNEIRO
Title or Position: OWNER
Credential: PT, DPT
Phone: 954-369-5787