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General NPI Number Information
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NPI Number | 1881972263
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Entity Type | Organization
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Legal Business Name | WELLNESS LIFESTYLES LLC
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 100 PENNSYLVANIA AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2512
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Country | US
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Telephone | 757-497-7809
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Fax | 757-301-5050
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Provider Business Mailing Address
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Address Line | 100 PENNSYLVANIA AVE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-2512
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Country | US
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Telephone | 757-497-7809
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Fax | 757-301-5050
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Authorized Official
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Title or Position | MEMBER
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Name | MR. JAMES KENNEDY VII
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Credential |
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Telephone | 757-497-7809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | VA
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