Provider Demographics
NPI:1194365841
Name:WELLNOS PLLC
Entity Type:Organization
Organization Name:WELLNOS PLLC
Other - Org Name:PHYSICAL THERAPY NOW SUNRISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:FONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-517-1219
Mailing Address - Street 1:4490 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-4513
Mailing Address - Country:US
Mailing Address - Phone:754-701-7274
Mailing Address - Fax:954-453-6065
Practice Address - Street 1:4490 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4513
Practice Address - Country:US
Practice Address - Phone:754-701-7274
Practice Address - Fax:954-453-6065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT33616OtherPT LICENSE
FLCH8692OtherMEDICAL LICENSE