Healthcare Provider Details

I. General information

NPI: 1548790108
Provider Name (Legal Business Name): ASHA WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8287 N PINE ISLAND RD
TAMARAC FL
33321-1541
US

IV. Provider business mailing address

8287 N PINE ISLAND RD
TAMARAC FL
33321-1541
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-6637
  • Fax: 954-720-6298
Mailing address:
  • Phone: 954-722-6637
  • Fax: 954-720-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberCH7931
License Number StateFL

VIII. Authorized Official

Name: ROXANN FRYE
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-722-6637