Healthcare Provider Details

I. General information

NPI: 1427140094
Provider Name (Legal Business Name): SPHINX WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 SE 177TH PL SUITE 406
SUMMERFIELD FL
34491-8975
US

IV. Provider business mailing address

PO BOX 1568
LADY LAKE FL
32158-1568
US

V. Phone/Fax

Practice location:
  • Phone: 352-307-6843
  • Fax: 352-307-9308
Mailing address:
  • Phone: 352-307-6843
  • Fax: 352-307-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ONSI N DERIAS
Title or Position: PRESIDENT
Credential: PT
Phone: 352-307-6843