Provider Demographics
NPI: | 1245755644 |
---|---|
Name: | FUSION HEALTH & WELLNESS LLC |
Entity Type: | Organization |
Organization Name: | FUSION HEALTH & WELLNESS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAUREN |
Authorized Official - Middle Name: | ELIZABETH |
Authorized Official - Last Name: | LIRA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 954-900-5635 |
Mailing Address - Street 1: | 1164 E OAKLAND PARK BLVD STE 102 |
Mailing Address - Street 2: | |
Mailing Address - City: | OAKLAND PARK |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33334-2709 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-900-5635 |
Mailing Address - Fax: | 954-990-7292 |
Practice Address - Street 1: | 1164 E OAKLAND PARK BLVD STE 102 |
Practice Address - Street 2: | |
Practice Address - City: | OAKLAND PARK |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33334 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-900-5635 |
Practice Address - Fax: | 954-990-7292 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-08-07 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | Group - Multi-Specialty |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 173000000X | Other Service Providers | Legal Medicine | Group - Multi-Specialty | |
No | 204R00000X | Allopathic & Osteopathic Physicians | Electrodiagnostic Medicine | Group - Multi-Specialty | |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
No | 2278P1005X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Rehabilitation | Group - Multi-Specialty |
No | 405300000X | Other Service Providers | Prevention Professional | Group - Multi-Specialty |