Provider Demographics
NPI:1073977666
Name:OUT OF THE BOX WELLNESS, INC
Entity Type:Organization
Organization Name:OUT OF THE BOX WELLNESS, INC
Other - Org Name:AUTISM FITNESS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-361-4493
Mailing Address - Street 1:12919 SW 133RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5851
Mailing Address - Country:US
Mailing Address - Phone:786-361-4493
Mailing Address - Fax:
Practice Address - Street 1:12919 SW 133RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5851
Practice Address - Country:US
Practice Address - Phone:786-361-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty