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General NPI Number Information
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NPI Number | 1548859192
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Entity Type | Organization
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Legal Business Name | WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) INC.
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 3330 PERKINSON LN MERRITT ISLAND FL 32953
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-3295
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Country | US
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Telephone | 321-412-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 3380 N TROPICAL TRL
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-8221
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Country | US
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Telephone | 321-412-8057
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA BRYAN
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Credential | MS HEALTH AND HUMAN
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Telephone | 321-412-8057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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