Provider Demographics
NPI:1972993962
Name:WELLNESS CENTERS OF TAMPA BAY, LLC
Entity type:Organization
Organization Name:WELLNESS CENTERS OF TAMPA BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-408-3232
Mailing Address - Street 1:5985 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2111
Mailing Address - Country:US
Mailing Address - Phone:727-408-3232
Mailing Address - Fax:877-455-2764
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:SUITE 9A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-408-3232
Practice Address - Fax:877-455-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty