Provider Demographics
NPI:1114451408
Name:WELLNESS REHAB OF SOUTH FLORIDA INC.
Entity Type:Organization
Organization Name:WELLNESS REHAB OF SOUTH FLORIDA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAIRILENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-866-7794
Mailing Address - Street 1:1600 S FEDERAL HWY STE 550
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7518
Mailing Address - Country:US
Mailing Address - Phone:561-866-7794
Mailing Address - Fax:954-657-8358
Practice Address - Street 1:1600 S FEDERAL HWY STE 550
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-7518
Practice Address - Country:US
Practice Address - Phone:561-866-7794
Practice Address - Fax:954-657-8358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
FLP17000009153261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP17000009153OtherDOCUMENT NUMBER