Provider Demographics
NPI:1134767296
Name:PINECREST WELLNESS L.L.C.
Entity type:Organization
Organization Name:PINECREST WELLNESS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:YACOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-326-0589
Mailing Address - Street 1:PO BOX 331942
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33233-1942
Mailing Address - Country:US
Mailing Address - Phone:305-929-0134
Mailing Address - Fax:305-670-0899
Practice Address - Street 1:9100 N KENDALL DR FL 1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2121
Practice Address - Country:US
Practice Address - Phone:305-929-0134
Practice Address - Fax:305-670-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy