Healthcare Provider Details

I. General information

NPI: 1275877326
Provider Name (Legal Business Name): WELLNESS THERAPY & MEDICAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST STE 301
HIALEAH FL
33012-3411
US

IV. Provider business mailing address

1140 W 50TH ST STE 301
HIALEAH FL
33012-3411
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-0208
  • Fax: 305-827-0280
Mailing address:
  • Phone: 305-827-0208
  • Fax: 305-827-0280

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: MR. BARBARA CORVO
Title or Position: PRESIDENT
Credential:
Phone: 305-827-0208