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General NPI Number Information
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NPI Number | 1447461819
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC WELLNESS CENTER
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 MADRID BLVD SUITE 411
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City | PUNTA GORDA
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State | FL
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Zip | 33950-7968
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Country | US
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Telephone | 941-833-3344
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Fax | 941-833-0328
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Provider Business Mailing Address
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Address Line | 100 MADRID BLVD SUITE 411
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City | PUNTA GORDA
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State | FL
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Zip | 33950-7968
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Country | US
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Telephone | 941-833-3344
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Fax | 941-833-0328
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Authorized Official
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Title or Position | THERAPIST
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Name | KATHLEEN KELLEY
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Credential | L.M.T
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Telephone | 941-833-3344
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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 | MM 12309
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License Number State | FL
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