Provider Demographics
NPI:1275943177
Name:FLORIDA WELLNESS CENTER INC.
Entity type:Organization
Organization Name:FLORIDA WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDANT
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-605-0781
Mailing Address - Street 1:4311 W. WATERS AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614
Mailing Address - Country:US
Mailing Address - Phone:813-605-0781
Mailing Address - Fax:813-605-0782
Practice Address - Street 1:4311 W. WATERS AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-605-0781
Practice Address - Fax:813-605-0782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 32182261QP2000X
FLMM35115261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy