Healthcare Provider Details

I. General information

NPI: 1588185045
Provider Name (Legal Business Name): WELLNESS BY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BEE RIDGE RD STE 9
SARASOTA FL
34233-1157
US

IV. Provider business mailing address

6150 DIAMOND CENTRE CT BLDG 100
FORT MYERS FL
33912-4367
US

V. Phone/Fax

Practice location:
  • Phone: 941-702-9575
  • Fax: 239-204-3000
Mailing address:
  • Phone: 239-768-6396
  • Fax: 239-204-3000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: GEORGE GHANEM
Title or Position: CEO
Credential:
Phone: 239-768-6396