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General NPI Number Information
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NPI Number | 1255069365
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Entity Type | Organization
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Legal Business Name | HEALING BODY & SOUL PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 5619 SILVER OAK DR
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City | FORT PIERCE
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State | FL
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Zip | 34982-3268
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Country | US
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Telephone | 305-742-8401
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Fax |
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Provider Business Mailing Address
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Address Line | 5619 SILVER OAK DR
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City | FORT PIERCE
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State | FL
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Zip | 34982-3268
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Country | US
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Telephone | 305-742-8401
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Fax |
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Authorized Official
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Title or Position | OWNER/ PTA
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Name | TATIANA YISSEL RODRIGUEZ
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Credential | PTA
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Telephone | 305-742-8401
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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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