MEDICARE: THERAPEUTIC 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	MM 12309	FL

General Provider Information

NPI Number	:	1447461819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC WELLNESS CENTER

Provider Business Mailing Address
First Line	:	100 MADRID BLVD
Second Line	:	SUITE 411
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7968
Country	:	US
Telephone Number	:	941-833-3344
Fax Number	:	941-833-0328

Provider Business Practice Location Address
First Line	:	100 MADRID BLVD
Second Line	:	SUITE 411
City	:	PUNTA GORDA
State	:	FL
Zip	:	33950-7968
Country	:	US
Telephone Number	:	941-833-3344
Fax Number	:	941-833-0328

Authorized Official
Title or Position	:	THERAPIST
Name	:	KATHLEEN KELLEY
Credential	:	L.M.T
Telephone Number	:	941-833-3344

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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Directions to “THERAPEUTIC WELLNESS CENTER ” Practice Location

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