Healthcare Provider Details

I. General information

NPI: 1730643727
Provider Name (Legal Business Name): WEST COAST WELLNESS OF SARASOTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 AIDAN LN
NORTH PORT FL
34287-4917
US

IV. Provider business mailing address

4361 AIDAN LN
NORTH PORT FL
34287-4917
US

V. Phone/Fax

Practice location:
  • Phone: 941-429-0070
  • Fax: 941-429-0032
Mailing address:
  • Phone: 941-294-0070
  • Fax: 941-429-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL M BARR
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 941-429-0070