MEDICARE: 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	225100000X	Physical Therapist	PT23947
2	171100000X	Acupuncturist	AP 1364

General Provider Information

NPI Number	:	1922378348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CENTER

Provider Business Mailing Address
First Line	:	3315 NE 16TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1711
Country	:	US
Telephone Number	:	954-565-6463
Fax Number	:	954-565-6463

Provider Business Practice Location Address
First Line	:	2720 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1627
Country	:	US
Telephone Number	:	954-675-5189
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HOWARD MOSKOW
Credential	:	A.P. , P.T.
Telephone Number	:	954-675-5189

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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Directions to “WELLNESS CENTER ” Practice Location

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