MEDICARE: I WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist
2	171100000X	Acupuncturist	AP3483	FL

General Provider Information

NPI Number	:	1134512817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1517 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4710
Country	:	US
Telephone Number	:	407-325-4577
Fax Number	:	888-487-1880

Provider Business Practice Location Address
First Line	:	1517 HILLCREST ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4710
Country	:	US
Telephone Number	:	407-325-4577
Fax Number	:	888-487-1880

Authorized Official
Title or Position	:	OWNER
Name	:	IVY VU
Credential	:	AP
Telephone Number	:	407-325-4577

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/17/2017

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Directions to “I WELLNESS CENTER ” Practice Location

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