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NPI 1720794522

NPI 1720794522 : SOWALHEALTH INC : MIRAMAR BEACH, FL

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General NPI Number Information
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    NPI Number           |    1720794522
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    Entity Type          |    Organization 
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    Legal Business Name  |    SOWALHEALTH INC 
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Dates
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    Enumeration Date     |    01/25/2023
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    Last Update Date     |    01/25/2023
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Provider Practice Location Address
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    Address Line         |    9375 EMERALD COAST PKWY W STE 27A 
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    City                 |    MIRAMAR BEACH
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    State                |    FL
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    Zip                  |    32550-7222
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    Country              |    US
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    Telephone            |    850-797-2711
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    Fax                  |    850-396-0587
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Provider Business Mailing Address
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    Address Line         |    9375 EMERALD COAST PKWY W STE 27A 
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    City                 |    MIRAMAR BEACH
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    State                |    FL
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    Zip                  |    32550-7222
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    Country              |    US
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    Telephone            |    850-797-2711
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    Fax                  |    
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Authorized Official
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    Title or Position    |    PRESIDENT
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    Name                 |    MR. BRIAN J PETRUCCI 
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    Credential           |    RPH
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    Telephone            |    850-797-2711
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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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