Provider Demographics
NPI:1922378348
Name:WELLNESS CENTER
Entity Type:Organization
Organization Name:WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSKOW
Authorized Official - Suffix:
Authorized Official - Credentials:AP , PT
Authorized Official - Phone:954-675-5189
Mailing Address - Street 1:3315 NE 16TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1711
Mailing Address - Country:US
Mailing Address - Phone:954-565-6463
Mailing Address - Fax:954-565-6463
Practice Address - Street 1:2720 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1627
Practice Address - Country:US
Practice Address - Phone:954-675-5189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AP 1364171100000X
PT23947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty