Provider Demographics
NPI:1720353931
Name:LUMANA PHYSICAL THERAPY & WELLNESS CENTER CORP
Entity type:Organization
Organization Name:LUMANA PHYSICAL THERAPY & WELLNESS CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-364-5409
Mailing Address - Street 1:810 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5712
Mailing Address - Country:US
Mailing Address - Phone:305-364-5409
Mailing Address - Fax:786-870-5927
Practice Address - Street 1:810 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5712
Practice Address - Country:US
Practice Address - Phone:305-364-5409
Practice Address - Fax:786-870-5927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24092261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102366900Medicaid