Provider Demographics
NPI:1043649858
Name:ADVANCED WELLNESS AND REHABILITATION CENTER, CORP.
Entity Type:Organization
Organization Name:ADVANCED WELLNESS AND REHABILITATION CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:813-968-7770
Mailing Address - Street 1:11736 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3504
Mailing Address - Country:US
Mailing Address - Phone:813-968-7770
Mailing Address - Fax:813-968-7717
Practice Address - Street 1:11736 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-3504
Practice Address - Country:US
Practice Address - Phone:813-968-7770
Practice Address - Fax:813-968-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center