Healthcare Provider Details

I. General information

NPI: 1174930317
Provider Name (Legal Business Name): THE CENTER OF WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 LOOKOUT PL SUITE 100
MAITLAND FL
32751-8433
US

IV. Provider business mailing address

237 LOOKOUT PL SUITE 100
MAITLAND FL
32751-8433
US

V. Phone/Fax

Practice location:
  • Phone: 407-335-4994
  • Fax: 321-203-2512
Mailing address:
  • Phone: 407-335-4994
  • Fax: 321-203-2512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10263
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2091/AP2330/AP2576
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA23315
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER HORNBURG
Title or Position: OWNER
Credential:
Phone: 407-256-7745