Healthcare Provider Details

I. General information

NPI: 1114451408
Provider Name (Legal Business Name): WELLNESS REHAB OF SOUTH FLORIDA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S FEDERAL HWY STE 550
POMPANO BEACH FL
33062-7518
US

IV. Provider business mailing address

1600 S FEDERAL HWY STE 550
POMPANO BEACH FL
33062-7518
US

V. Phone/Fax

Practice location:
  • Phone: 561-866-7794
  • Fax: 954-657-8358
Mailing address:
  • Phone: 561-866-7794
  • Fax: 954-657-8358

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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberP17000009153
License Number StateFL

VIII. Authorized Official

Name: JAIRILENA M VIANA
Title or Position: CEO
Credential:
Phone: 561-866-7794