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General NPI Number Information
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NPI Number | 1417255076
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Entity Type | Organization
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Legal Business Name | WELLNESS THERAPY SERVICE CENTER INC.
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 03/07/2011
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Provider Practice Location Address
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Address Line | 701 SW 27TH AVE STE 960
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City | MIAMI
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State | FL
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Zip | 33135-3000
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Country | US
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Telephone | 786-536-6318
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Fax | 305-642-5302
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Provider Business Mailing Address
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Address Line | 701 SW 27TH AVE STE 960
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City | MIAMI
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State | FL
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Zip | 33135-3000
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Country | US
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Telephone | 786-536-6318
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Fax | 305-642-5302
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MR. ROBERTO PEREZ
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Credential | M.T.
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Telephone | 786-536-3718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | MM 26317
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License Number State | FL
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