Healthcare Provider Details

I. General information

NPI: 1861795585
Provider Name (Legal Business Name): WELLNESS AND REHAB SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2531 SW FONDURA RD
PORT SAINT LUCIE FL
34953-2773
US

IV. Provider business mailing address

2531 SW FONDURA RD
PORT SAINT LUCIE FL
34953-2773
US

V. Phone/Fax

Practice location:
  • Phone: 772-348-4272
  • Fax: 772-348-4612
Mailing address:
  • Phone: 772-348-4272
  • Fax: 772-348-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARY EDGAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 480-206-6240