Provider Demographics
NPI:1093306292
Name:PERSONAL WELLNESS MEDICINE, LLC
Entity Type:Organization
Organization Name:PERSONAL WELLNESS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-685-8914
Mailing Address - Street 1:651 SE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-5003
Mailing Address - Country:US
Mailing Address - Phone:941-685-8914
Mailing Address - Fax:
Practice Address - Street 1:3231 GULF GATE DR STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-2406
Practice Address - Country:US
Practice Address - Phone:941-685-8914
Practice Address - Fax:941-349-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty