Healthcare Provider Details

I. General information

NPI: 1578010112
Provider Name (Legal Business Name): WELLNESS HEALTH ACUPUNCTURE & PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 FRANKLIN ST
OCOEE FL
34761-2644
US

IV. Provider business mailing address

899 CAVAN DR
APOPKA FL
32703-8344
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-9576
  • Fax: 407-347-9598
Mailing address:
  • Phone: 407-967-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP3737
License Number StateFL

VIII. Authorized Official

Name: YVES MICHEL SURIN
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: AP
Phone: 407-967-1056