Provider Demographics
NPI:1578694915
Name:HOLISTIC MASSAGE & WELLNESS CLINICS
Entity Type:Organization
Organization Name:HOLISTIC MASSAGE & WELLNESS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLERITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-893-7233
Mailing Address - Street 1:570 OCEAN BLVD
Mailing Address - Street 2:#501
Mailing Address - City:JUNO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:954-491-2225
Mailing Address - Fax:954-491-6862
Practice Address - Street 1:903 EAST CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-491-2225
Practice Address - Fax:954-491-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10479225700000X
MA10480225700000X
MA10481225700000X
MA10482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty