Provider Demographics
NPI:1568877645
Name:PHYSICAL AND MENTAL WELLNESS CORP.
Entity Type:Organization
Organization Name:PHYSICAL AND MENTAL WELLNESS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-299-0815
Mailing Address - Street 1:5400 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 408
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5312
Mailing Address - Country:US
Mailing Address - Phone:305-299-0815
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR
Practice Address - Street 2:SUITE 408
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5312
Practice Address - Country:US
Practice Address - Phone:305-299-0815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty