Healthcare Provider Details

I. General information

NPI: 1811245368
Provider Name (Legal Business Name): INTENTION WELLNESS INC., PHYSICAL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15207 SW 176TH LN
MIAMI FL
33187-1620
US

IV. Provider business mailing address

15207 SW 176TH LN
MIAMI FL
33187-1620
US

V. Phone/Fax

Practice location:
  • Phone: 305-209-5050
  • Fax: 305-235-5050
Mailing address:
  • Phone: 305-209-5050
  • Fax: 305-235-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17965
License Number StateFL

VIII. Authorized Official

Name: LOURDES M PALMER
Title or Position: PRESIDENT/OWNER
Credential: PT
Phone: 305-209-5050