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General NPI Number Information
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NPI Number | 1699366385
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Entity Type | Organization
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Legal Business Name | WELLQUEST LIFESTYLE REHABILITATION, LLC
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 345 E ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5253
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Country | US
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Telephone | 813-404-6006
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Fax |
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Provider Business Mailing Address
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Address Line | 110 MITCHELL DR
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City | BRANDON
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State | FL
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Zip | 33511-6831
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Country | US
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Telephone | 813-404-6006
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Fax |
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Authorized Official
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Title or Position | MEDICAL BILLING ASSOCIATE
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Name | CAMILLE CLARK
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Credential |
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Telephone | 754-205-6154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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