Provider Demographics
NPI:1609011501
Name:THE INSTITUTE FOR WELLBEING LLC
Entity Type:Organization
Organization Name:THE INSTITUTE FOR WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:386-763-2338
Mailing Address - Street 1:802 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4931
Mailing Address - Country:US
Mailing Address - Phone:386-763-2338
Mailing Address - Fax:
Practice Address - Street 1:802 DUNLAWTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4931
Practice Address - Country:US
Practice Address - Phone:386-763-2338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty