Provider Demographics
NPI:1891000121
Name:WELLCARE THERAPEUTIC INC
Entity Type:Organization
Organization Name:WELLCARE THERAPEUTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:305-822-7002
Mailing Address - Street 1:3750 W 16TH AVE STE 238U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4665
Mailing Address - Country:US
Mailing Address - Phone:305-822-7002
Mailing Address - Fax:305-822-7009
Practice Address - Street 1:3750 W 16TH AVE STE 238U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4665
Practice Address - Country:US
Practice Address - Phone:305-822-7002
Practice Address - Fax:305-822-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25377261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy