Provider Demographics
NPI:1467681783
Name:WELLNESS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WELLNESS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:FLORIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-673-0017
Mailing Address - Street 1:45-277 KA HANAHOU CIR APT B
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3056
Mailing Address - Country:US
Mailing Address - Phone:808-673-0017
Mailing Address - Fax:
Practice Address - Street 1:45-277 KA HANAHOU CIR APT B
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3056
Practice Address - Country:US
Practice Address - Phone:808-673-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2740261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy