Provider Demographics
NPI:1699366385
Name:WELLQUEST LIFESTYLE REHABILITATION, LLC
Entity Type:Organization
Organization Name:WELLQUEST LIFESTYLE REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-205-6154
Mailing Address - Street 1:110 MITCHELL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6831
Mailing Address - Country:US
Mailing Address - Phone:813-404-6006
Mailing Address - Fax:
Practice Address - Street 1:345 E ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5253
Practice Address - Country:US
Practice Address - Phone:813-404-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty