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General NPI Number Information
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NPI Number | 1699451849
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Entity Type | Organization
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Legal Business Name | HOLISTIC HEALTH PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 24850 BURNT PINE DR STE 3
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-0905
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Country | US
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Telephone | 239-230-3905
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Fax | 888-624-3518
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Provider Business Mailing Address
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Address Line | 22475 FOUNTAIN LAKES BLVD
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City | ESTERO
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State | FL
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Zip | 33928-2325
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Country | US
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Telephone | 630-415-4638
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Fax | 888-624-3518
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | BRIANA WYATT
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Credential | PT, DPT
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Telephone | 630-415-4638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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