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General NPI Number Information
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NPI Number | 1487946448
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Entity Type | Organization
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Legal Business Name | WELLNESS AND AESTHETICS INSTITUTE, PA
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 2020 W STATE HIGHWAY 114 SUITE 260
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City | GRAPEVINE
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State | TX
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Zip | 76051-8649
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Country | US
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Telephone | 817-481-6342
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Fax | 817-442-4848
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Provider Business Mailing Address
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Address Line | 2020 W STATE HIGHWAY 114 SUITE 260
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City | GRAPEVINE
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State | TX
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Zip | 76051-8649
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Country | US
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Telephone | 817-481-6342
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Fax | 817-442-4848
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. BEVERLY D KOTSANIS
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Credential |
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Telephone | 817-481-6342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G5951
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | G5951
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | G5951
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License Number State | TX
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