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General NPI Number Information
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NPI Number | 1548947872
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL OKINAWAN KARATE ACADEMY & WELLNESS
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 1121 W BELL RD STE 373
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City | PHOENIX
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State | AZ
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Zip | 85023-3516
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Country | US
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Telephone | 888-516-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 W SWEETWATER AVE APT 1036
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City | PHOENIX
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State | AZ
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Zip | 85029-1390
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Country | US
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Telephone | 888-516-1966
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Fax |
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Authorized Official
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Title or Position | BHT/FACILITATOR/WELLNESS COACH
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Name | MR. WALLACE CLYDE ANDREWS III
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Credential | CHIEF INSTRUCTOR
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Telephone | 480-925-1393
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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 |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 226000000X
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Taxonomy Name | Recreational Therapist Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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