Healthcare Provider Details

I. General information

NPI: 1811296304
Provider Name (Legal Business Name): WELLNESS & BALANCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE SUITE 324
DORAL FL
33166-6556
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 324
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-599-7709
  • Fax:
Mailing address:
  • Phone: 305-599-7709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM26420
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LILLIAM MADIC
Title or Position: DIRECTOR
Credential: THERAPIST
Phone: 954-410-1607