Healthcare Provider Details

I. General information

NPI: 1417065210
Provider Name (Legal Business Name): BACK TO HEALTH WELLNESS CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 UNIVERSITY PKWY
SARASOTA FL
34243-2412
US

IV. Provider business mailing address

2920 UNIVERSITY PKWY
SARASOTA FL
34243-2412
US

V. Phone/Fax

Practice location:
  • Phone: 941-351-2555
  • Fax: 941-359-8657
Mailing address:
  • Phone: 941-351-2555
  • Fax: 941-359-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH6785
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT15223
License Number StateFL

VIII. Authorized Official

Name: DONNA L WEISS
Title or Position: OFFICE MANAGER
Credential:
Phone: 941-351-2555