Provider Demographics
NPI:1952845919
Name:ESENCIA WELLNESS & THERAPY LLC.
Entity Type:Organization
Organization Name:ESENCIA WELLNESS & THERAPY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:GODOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-318-4439
Mailing Address - Street 1:4431 SW 64TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3458
Mailing Address - Country:US
Mailing Address - Phone:954-316-1476
Mailing Address - Fax:954-316-1130
Practice Address - Street 1:4431 SW 64TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3458
Practice Address - Country:US
Practice Address - Phone:954-316-1476
Practice Address - Fax:954-316-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-10
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 261QR0401X
FLPTA23618225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty