Provider Demographics
NPI:1417255076
Name:WELLNESS THERAPY SERVICE CENTER INC.
Entity type:Organization
Organization Name:WELLNESS THERAPY SERVICE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:786-536-3718
Mailing Address - Street 1:701 SW 27TH AVE STE 960
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3000
Mailing Address - Country:US
Mailing Address - Phone:786-536-6318
Mailing Address - Fax:305-642-5302
Practice Address - Street 1:701 SW 27TH AVE STE 960
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3000
Practice Address - Country:US
Practice Address - Phone:786-536-6318
Practice Address - Fax:305-642-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM 26317261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)