Provider Demographics
NPI:1518222934
Name:TOTAL BODY WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:TOTAL BODY WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-235-9096
Mailing Address - Street 1:18400 NW 75TH PL
Mailing Address - Street 2:#119
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2955
Mailing Address - Country:US
Mailing Address - Phone:786-235-9096
Mailing Address - Fax:786-953-7645
Practice Address - Street 1:18400 NW 75TH PL
Practice Address - Street 2:#119
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2955
Practice Address - Country:US
Practice Address - Phone:786-235-9096
Practice Address - Fax:786-953-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care