Healthcare Provider Details

I. General information

NPI: 1033414990
Provider Name (Legal Business Name): FLORIDA WELLNESS & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N FRANKLIN ST STE A
TAMPA FL
33602-5831
US

IV. Provider business mailing address

101 N FRANKLIN ST STE A
TAMPA FL
33602-5831
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-2225
  • Fax: 813-221-2225
Mailing address:
  • Phone: 813-229-2225
  • Fax: 813-221-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9507
License Number StateFL

VIII. Authorized Official

Name: ANDREW GOLD
Title or Position: OFFICE MANAGER
Credential: PH.D.
Phone: 813-229-2225