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General NPI Number Information
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NPI Number | 1467366021
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Entity Type | Organization
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Legal Business Name | FLORIDA FITWAVE
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Dates
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Enumeration Date | 09/30/2026
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Last Update Date | 09/30/2026
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Provider Practice Location Address
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Address Line | 107 W 23RD ST STE W8
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City | PANAMA CITY
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State | FL
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Zip | 32405-7619
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Country | US
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Telephone | 850-818-8184
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Fax |
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Provider Business Mailing Address
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Address Line | 107 W 23RD ST STE W8
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City | PANAMA CITY
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State | FL
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Zip | 32405-7619
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Country | US
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Telephone | 850-628-8853
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICAL
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Name | DANIEL JOSEPH WILLEMS
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Credential |
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Telephone | 850-628-8853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State | NULL
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