MEDICARE: SOBE WELL, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	261QM1300X	Multi-Specialty Clinic/Center
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1194582619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOBE WELL, LLC

Provider Business Mailing Address
First Line	:	1440 SEAWAY DR # 1
Second Line	:
City	:	HUTCHINSON ISLAND
State	:	FL
Zip	:	34949-3152
Country	:	US
Telephone Number	:	954-294-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 SEAWAY DR # 1
Second Line	:
City	:	HUTCHINSON ISLAND
State	:	FL
Zip	:	34949-3152
Country	:	US
Telephone Number	:	954-294-7638
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. PATRECE A FRISBEE
Credential	:	DC
Telephone Number	:	954-294-7638

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	03/01/2024

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