MEDICARE: GH2 WELLNESS LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841183662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GH2 WELLNESS LLC

Provider Business Mailing Address
First Line	:	295 NW COMMONS LOOP STE 115-122
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7721
Country	:	US
Telephone Number	:	407-497-0827
Fax Number	:

Provider Business Practice Location Address
First Line	:	2172 SE BAYA DR STE 102
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32025-4921
Country	:	US
Telephone Number	:	386-243-0592
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARCUS ANDERSON
Credential	:	DPT
Telephone Number	:	407-497-0827

Provider Enumeration Date	:	05/30/2025
Last Update Date	:	05/30/2025

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Directions to “GH2 WELLNESS LLC ” Practice Location

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