Healthcare Provider Details

I. General information

NPI: 1780214999
Provider Name (Legal Business Name): RIVERVIEW WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10672 BLOOMINGDALE AVE
RIVERVIEW FL
33578-4290
US

IV. Provider business mailing address

9858 CLINT MOORE RD # C111-274
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-3775
  • Fax: 813-374-4122
Mailing address:
  • Phone: 561-482-1144
  • Fax: 561-482-1145

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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED INSHAN
Title or Position: OWNER
Credential: DC
Phone: 813-374-3775