Provider Demographics
NPI:1386610541
Name:PREMIER WELLNESS & REHAB INC
Entity type:Organization
Organization Name:PREMIER WELLNESS & REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DE VLEESCHAUWER
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:561-758-5817
Mailing Address - Street 1:800 131TERRACE
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-758-5817
Mailing Address - Fax:561-792-1961
Practice Address - Street 1:800 131TERRACE
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-758-5817
Practice Address - Fax:561-792-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0011417261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2103AMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
FLK5320Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER