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General NPI Number Information
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NPI Number | 1851609044
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Entity Type | Organization
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Legal Business Name | WELLNESS THERAPEUTIC CENTER
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 5901 SW 74TH ST
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5165
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Country | US
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Telephone | 305-704-7910
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Fax | 786-235-8920
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Provider Business Mailing Address
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Address Line | 15021 SW 180TH TER
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City | MIAMI
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State | FL
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Zip | 33187-6278
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Country | US
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Telephone | 305-238-5931
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Fax | 305-238-5787
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Authorized Official
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Title or Position | OWNER
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Name | MS. YESENIA URRUTIA
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Credential | LMT
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Telephone | 305-704-7910
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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 | MA45849
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License Number State | FL
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