Provider Demographics
NPI:1306260161
Name:BWELL REHAB LLC
Entity type:Organization
Organization Name:BWELL REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VISHNEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:941-484-9291
Mailing Address - Street 1:405 COMMERCIAL CT STE A
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1653
Mailing Address - Country:US
Mailing Address - Phone:718-640-7917
Mailing Address - Fax:
Practice Address - Street 1:405 COMMERCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1653
Practice Address - Country:US
Practice Address - Phone:941-484-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6600235Z00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS888AMedicare PIN