Healthcare Provider Details

I. General information

NPI: 1669610796
Provider Name (Legal Business Name): FITNESS & WELLNESS WORKS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 TOWN CENTER CIR SUITE A
WESTON FL
33326-3637
US

IV. Provider business mailing address

934 N UNIVERSITY DR SUITE 219
CORAL SPRINGS FL
33071-7029
US

V. Phone/Fax

Practice location:
  • Phone: 954-385-3456
  • Fax:
Mailing address:
  • Phone: 954-227-1690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. RAFAEL CANELO
Title or Position: CEO
Credential:
Phone: 954-465-6900