Provider Demographics
NPI:1457658577
Name:APALACHICOLA WELLNESS, LLC
Entity Type:Organization
Organization Name:APALACHICOLA WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BROCATO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-653-4545
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0207
Mailing Address - Country:US
Mailing Address - Phone:850-653-4545
Mailing Address - Fax:850-653-4949
Practice Address - Street 1:111 AVENUE E
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2041
Practice Address - Country:US
Practice Address - Phone:850-653-4545
Practice Address - Fax:850-653-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty