Provider Demographics
NPI:1932665668
Name:OPTIMAL WELLNESS REDEFINED, LLC
Entity Type:Organization
Organization Name:OPTIMAL WELLNESS REDEFINED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-901-7704
Mailing Address - Street 1:7560 RED BUG LAKE ROAD
Mailing Address - Street 2:SUITE #1080
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6601
Mailing Address - Country:US
Mailing Address - Phone:407-901-7704
Mailing Address - Fax:407-288-8582
Practice Address - Street 1:2765 REBECCA LN STE D
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8326
Practice Address - Country:US
Practice Address - Phone:407-901-7704
Practice Address - Fax:407-288-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty