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General NPI Number Information
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NPI Number | 1811296304
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Entity Type | Organization
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Legal Business Name | WELLNESS & BALANCE CENTER
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE SUITE 324
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 305-599-7709
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Fax |
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Provider Business Mailing Address
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Address Line | 3900 NW 79TH AVE SUITE 324
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 305-599-7709
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. LILLIAM MADIC
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Credential | THERAPIST
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Telephone | 954-410-1607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM26420
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License Number State | FL
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