Provider Demographics
NPI:1215752076
Name:WELLB4LIFE,LLC
Entity type:Organization
Organization Name:WELLB4LIFE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DR. COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA DACM PHD
Authorized Official - Phone:415-404-2567
Mailing Address - Street 1:15 PARADISE PLZ STE 389
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6905
Mailing Address - Country:US
Mailing Address - Phone:415-404-2567
Mailing Address - Fax:
Practice Address - Street 1:2805 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5378
Practice Address - Country:US
Practice Address - Phone:415-404-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health