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General NPI Number Information
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NPI Number | 1093306292
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Entity Type | Organization
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Legal Business Name | PERSONAL WELLNESS MEDICINE, LLC
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Dates
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Enumeration Date | 01/30/2021
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Last Update Date | 01/30/2021
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Provider Practice Location Address
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Address Line | 3231 GULF GATE DR STE 102
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City | SARASOTA
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State | FL
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Zip | 34231-2406
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Country | US
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Telephone | 941-685-8914
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Fax | 941-349-9301
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Provider Business Mailing Address
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Address Line | 651 SE 41ST AVE
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City | TRENTON
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State | FL
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Zip | 32693-5003
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Country | US
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Telephone | 941-685-8914
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | DAVID LEGGETT
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Credential |
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Telephone | 941-685-8914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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