Healthcare Provider Details

I. General information

NPI: 1366714826
Provider Name (Legal Business Name): AFTERMATH WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 NW 7TH AVE
NORTH MIAMI FL
33168-2525
US

IV. Provider business mailing address

12010 NW 7TH AVE
NORTH MIAMI FL
33168-2525
US

V. Phone/Fax

Practice location:
  • Phone: 305-769-1022
  • Fax: 305-769-1088
Mailing address:
  • Phone: 305-769-1022
  • Fax: 305-769-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberHCC8984
License Number StateFL

VIII. Authorized Official

Name: MR. ANTHONY SWAIN
Title or Position: PRESIDENT
Credential:
Phone: 305-769-1022