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General NPI Number Information
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NPI Number | 1679226286
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Entity Type | Organization
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Legal Business Name | WELLNESS FIRM LLC
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Dates
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Enumeration Date | 02/02/2022
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 29817 US HIGHWAY 19 N
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City | CLEARWATER
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State | FL
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Zip | 33761-1527
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Country | US
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Telephone | 727-431-6869
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Fax |
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Provider Business Mailing Address
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Address Line | 12191 W LINEBAUGH AVE # 624
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City | TAMPA
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State | FL
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Zip | 33626-1732
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VINCENT SUPERNOR
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Credential |
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Telephone | 727-410-4828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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