Provider Demographics
NPI:1104291756
Name:THE WELLNESS GROUP OF TAMPA, LLC
Entity type:Organization
Organization Name:THE WELLNESS GROUP OF TAMPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANKIE
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:813-701-1234
Mailing Address - Street 1:1910 ORIENT RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-3354
Mailing Address - Country:US
Mailing Address - Phone:813-701-1234
Mailing Address - Fax:813-630-4670
Practice Address - Street 1:1910 ORIENT RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-3354
Practice Address - Country:US
Practice Address - Phone:813-701-1234
Practice Address - Fax:813-630-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85148261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty