Healthcare Provider Details

I. General information

NPI: 1871284034
Provider Name (Legal Business Name): WELLNESS RECLAMATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 MOSS PARK RD
ORLANDO FL
32832-6086
US

IV. Provider business mailing address

195 WEKIVA SPRINGS RD STE 224
LONGWOOD FL
32779-3696
US

V. Phone/Fax

Practice location:
  • Phone: 787-617-7310
  • Fax:
Mailing address:
  • Phone: 787-617-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL J COLON
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 787-617-7310