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General NPI Number Information
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NPI Number | 1518222934
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Entity Type | Organization
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Legal Business Name | TOTAL BODY WELLNESS CLINIC, LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 18400 NW 75TH PL #119
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City | HIALEAH
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State | FL
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Zip | 33015-2955
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Country | US
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Telephone | 786-235-9096
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Fax | 786-953-7645
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Provider Business Mailing Address
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Address Line | 18400 NW 75TH PL #119
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City | HIALEAH
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State | FL
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Zip | 33015-2955
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Country | US
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Telephone | 786-235-9096
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Fax | 786-953-7645
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CAROL JOHNSON
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Credential |
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Telephone | 786-235-9096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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