Provider Demographics
NPI:1053326926
Name:JACOLBY WELLNESS INSTITUTE INC
Entity Type:Organization
Organization Name:JACOLBY WELLNESS INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:305-553-3254
Mailing Address - Street 1:14708 SW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4041
Mailing Address - Country:US
Mailing Address - Phone:305-553-3254
Mailing Address - Fax:800-957-8356
Practice Address - Street 1:14708 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4041
Practice Address - Country:US
Practice Address - Phone:305-553-3254
Practice Address - Fax:800-957-8356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2693Medicare ID - Type UnspecifiedMEDICARE PROVIDER