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General NPI Number Information
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NPI Number | 1134767296
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Entity Type | Organization
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Legal Business Name | PINECREST WELLNESS L.L.C.
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 9100 N KENDALL DR FL 1
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City | MIAMI
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State | FL
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Zip | 33176-2121
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Country | US
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Telephone | 305-929-0134
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Fax | 305-670-0899
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Provider Business Mailing Address
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Address Line | PO BOX 331942
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City | MIAMI
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State | FL
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Zip | 33233-1942
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Country | US
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Telephone | 305-929-0134
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Fax | 305-670-0899
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Authorized Official
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Title or Position | OWNER
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Name | RONALD YACOUB
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Credential |
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Telephone | 954-326-0589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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