Healthcare Provider Details

I. General information

NPI: 1134512817
Provider Name (Legal Business Name): I WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 HILLCREST ST
ORLANDO FL
32803-4710
US

IV. Provider business mailing address

1517 HILLCREST ST
ORLANDO FL
32803-4710
US

V. Phone/Fax

Practice location:
  • Phone: 407-325-4577
  • Fax: 888-487-1880
Mailing address:
  • Phone: 407-325-4577
  • Fax: 888-487-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3483
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: IVY VU
Title or Position: OWNER
Credential: AP
Phone: 407-325-4577