MEDICARE: INNOVATIVE WELLNESS, INC.

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1679359079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE WELLNESS, INC.

Provider Business Mailing Address
First Line	:	29250 US HIGHWAY 19 N LOT 40
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-2169
Country	:	US
Telephone Number	:	239-390-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 CURLEW RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6823
Country	:	US
Telephone Number	:	239-390-1800
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURE PHYSICIAN
Name	:	DIANE R SARRA
Credential	:	DOM
Telephone Number	:	239-390-1800

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	09/01/2023

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