Provider Demographics
NPI:1578162780
Name:FOURTH TRIMESTER WELLNESS LLC
Entity Type:Organization
Organization Name:FOURTH TRIMESTER WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:813-767-9716
Mailing Address - Street 1:711 CHANCELLAR DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4512
Mailing Address - Country:US
Mailing Address - Phone:813-767-9716
Mailing Address - Fax:
Practice Address - Street 1:711 CHANCELLAR DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4512
Practice Address - Country:US
Practice Address - Phone:813-336-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy