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General NPI Number Information
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NPI Number | 1023677630
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY WELLNESS GROUP
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 05/23/2020
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Provider Practice Location Address
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Address Line | 519 SW NAGLE PLACE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953
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Country | US
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Telephone | 772-209-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 10380 SW VILLAGE CENTER DR # 355
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1931
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Country | US
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Telephone | 772-209-1183
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. SPERANCIA ANNA WHITE
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Credential | DPT
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Telephone | 772-209-1183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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