Healthcare Provider Details

I. General information

NPI: 1457018582
Provider Name (Legal Business Name): EPIC WELLNESS FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 W HARBORVIEW RD
SANTA ROSA BEACH FL
32459-3056
US

IV. Provider business mailing address

188 W HARBORVIEW RD
SANTA ROSA BEACH FL
32459-3056
US

V. Phone/Fax

Practice location:
  • Phone: 850-901-0554
  • Fax:
Mailing address:
  • Phone: 850-901-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CALLIE KNIGHT
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-901-0554