Provider Demographics
NPI:1972216182
Name:ROOTED WELLNESS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ROOTED WELLNESS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA
Authorized Official - Middle Name:
Authorized Official - Last Name:INCERA-GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:305-608-4517
Mailing Address - Street 1:5863 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5311
Mailing Address - Country:US
Mailing Address - Phone:305-608-4517
Mailing Address - Fax:
Practice Address - Street 1:145 MADEIRA AVE STE 206
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4520
Practice Address - Country:US
Practice Address - Phone:305-608-4517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy