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General NPI Number Information
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NPI Number | 1518208750
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Entity Type | Organization
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Legal Business Name | WHOLE HEALTHY FAMILY
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 2874 MERRICK RD
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City | BELLMORE
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State | NY
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Zip | 11710-5726
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Country | US
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Telephone | 516-221-1212
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Fax | 516-221-1292
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Provider Business Mailing Address
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Address Line | 2874 MERRICK RD
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City | BELLMORE
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State | NY
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Zip | 11710-5726
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Country | US
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Telephone | 516-221-1212
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Fax | 516-221-1292
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DANA LYN WALTERS
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Credential | DC
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Telephone | 516-221-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 012786
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 193423
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License Number State | NY
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