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General NPI Number Information
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NPI Number | 1356618185
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Entity Type | Organization
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Legal Business Name | WHOLESOME FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 11/22/2011
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 4420 NW 28TH WAY
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City | BOCA RATON
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State | FL
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Zip | 33434-5819
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Country | US
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Telephone | 561-577-4860
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Fax | 561-509-7621
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Provider Business Mailing Address
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Address Line | 4420 NW 28TH WAY
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City | BOCA RATON
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State | FL
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Zip | 33434-5819
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Country | US
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Telephone | 561-577-4860
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Fax | 561-509-7621
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDER P SOAVE
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Credential | DPT, LMT
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Telephone | 561-577-4860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA52832
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT25905
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License Number State | FL
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