Healthcare Provider Details

I. General information

NPI: 1922378348
Provider Name (Legal Business Name): WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E OAKLAND PARK BLVD
FORT LAUDERDALE FL
33306-1627
US

IV. Provider business mailing address

3315 NE 16TH ST
FORT LAUDERDALE FL
33304-1711
US

V. Phone/Fax

Practice location:
  • Phone: 954-675-5189
  • Fax:
Mailing address:
  • Phone: 954-565-6463
  • Fax: 954-565-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 1364
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT23947
License Number State

VIII. Authorized Official

Name: MR. HOWARD MOSKOW
Title or Position: PRESIDENT
Credential: A.P. , P.T.
Phone: 954-675-5189