Provider Demographics
NPI:1760528129
Name:WELLER, PATRICIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BODY
Other - Middle Name:AND SOUL
Other - Last Name:WELLNESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INC
Mailing Address - Street 1:784 US HIGHWAY 1
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4415
Mailing Address - Country:US
Mailing Address - Phone:561-625-3040
Mailing Address - Fax:954-963-7169
Practice Address - Street 1:784 US HIGHWAY 1
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4415
Practice Address - Country:US
Practice Address - Phone:561-625-3040
Practice Address - Fax:954-963-7169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7972OtherBLUE CROSS BLUE SHEILD