Healthcare Provider Details

I. General information

NPI: 1902660483
Provider Name (Legal Business Name): WENDY JO BAKAL LMT, NBHWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JO BAKAL LMT, NBHWC

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9617 N OKLAWAHA AVE
TAMPA FL
33617-4529
US

IV. Provider business mailing address

9617 N OKLAWAHA AVE
TAMPA FL
33617-4529
US

V. Phone/Fax

Practice location:
  • Phone: 917-439-1623
  • Fax:
Mailing address:
  • Phone: 917-439-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3253495
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA95252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: