Provider Demographics
NPI:1033368329
Name:WELLNESS WISE, INC.
Entity Type:Organization
Organization Name:WELLNESS WISE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:HENKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-812-9953
Mailing Address - Street 1:6800 NW MONOCO CT
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-5376
Mailing Address - Country:US
Mailing Address - Phone:772-812-9953
Mailing Address - Fax:772-871-7842
Practice Address - Street 1:1001 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-4142
Practice Address - Country:US
Practice Address - Phone:772-812-9953
Practice Address - Fax:772-871-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37838225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2393OtherBCBSFL