Healthcare Provider Details

I. General information

NPI: 1518325661
Provider Name (Legal Business Name): GABRY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12773 FOREST HILL BLVD #1213
WELLINGTON FL
33414-4767
US

IV. Provider business mailing address

12773 FOREST HILL BLVD #1213
WELLINGTON FL
33414-4767
US

V. Phone/Fax

Practice location:
  • Phone: 561-510-4355
  • Fax: 561-336-9192
Mailing address:
  • Phone: 561-510-4355
  • Fax: 561-336-9192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME126599
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA80691
License Number StateFL

VIII. Authorized Official

Name: KAMAL GABRY
Title or Position: OWNER
Credential: M.D.
Phone: 561-510-4355