Provider Demographics
NPI:1497063556
Name:ALIVE & WELL A HOLISTIC CENTER
Entity Type:Organization
Organization Name:ALIVE & WELL A HOLISTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELI
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKROYD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, ND
Authorized Official - Phone:239-226-9355
Mailing Address - Street 1:9250 COLLEGE PKWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5804
Mailing Address - Country:US
Mailing Address - Phone:239-226-9355
Mailing Address - Fax:239-226-9351
Practice Address - Street 1:9250 COLLEGE PKWY
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5804
Practice Address - Country:US
Practice Address - Phone:239-226-9355
Practice Address - Fax:239-226-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM21660225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty