Provider Demographics
NPI:1518325661
Name:GABRY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:GABRY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-510-4355
Mailing Address - Street 1:12773 FOREST HILL BLVD
Mailing Address - Street 2:#1213
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4767
Mailing Address - Country:US
Mailing Address - Phone:561-510-4355
Mailing Address - Fax:561-336-9192
Practice Address - Street 1:12773 FOREST HILL BLVD
Practice Address - Street 2:#1213
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4767
Practice Address - Country:US
Practice Address - Phone:561-510-4355
Practice Address - Fax:561-336-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA80691225700000X
FLME126599261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty