Provider Demographics
NPI:1447807375
Name:COREMOTION WELLNESS
Entity Type:Organization
Organization Name:COREMOTION WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-372-4016
Mailing Address - Street 1:2449 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-4066
Mailing Address - Country:US
Mailing Address - Phone:904-372-4016
Mailing Address - Fax:
Practice Address - Street 1:2449 3RD ST S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-4066
Practice Address - Country:US
Practice Address - Phone:904-372-4016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy