Provider Demographics
NPI:1679861298
Name:HEALTH & WELLNESS MOBILE THERAPY
Entity Type:Organization
Organization Name:HEALTH & WELLNESS MOBILE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PURI
Authorized Official - Suffix:II
Authorized Official - Credentials:LMT
Authorized Official - Phone:786-286-9134
Mailing Address - Street 1:9175 SW 138TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1275
Mailing Address - Country:US
Mailing Address - Phone:786-286-9134
Mailing Address - Fax:786-359-4237
Practice Address - Street 1:9175 SW 138TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1275
Practice Address - Country:US
Practice Address - Phone:786-286-9134
Practice Address - Fax:786-359-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-17
Last Update Date:2011-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51643261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain