Provider Demographics
NPI:1689011488
Name:ULTIMATE WELLNESS REHAB LLC
Entity Type:Organization
Organization Name:ULTIMATE WELLNESS REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-206-5200
Mailing Address - Street 1:3524 TAMIAMI TRL STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8155
Mailing Address - Country:US
Mailing Address - Phone:941-764-9695
Mailing Address - Fax:941-764-9694
Practice Address - Street 1:3524 TAMIAMI TRL STE 103
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8155
Practice Address - Country:US
Practice Address - Phone:941-764-9695
Practice Address - Fax:941-764-9694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty