Provider Demographics
NPI:1043894660
Name:PROFESSIONAL WELLNESS ASSOCIATES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL WELLNESS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBELIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-757-4272
Mailing Address - Street 1:16855 NE 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1744
Mailing Address - Country:US
Mailing Address - Phone:305-705-3455
Mailing Address - Fax:
Practice Address - Street 1:16855 NE 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1744
Practice Address - Country:US
Practice Address - Phone:305-705-3455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation