Provider Demographics
NPI:1164793204
Name:PHYSICIANS WELLNESS CENTERS, INC
Entity type:Organization
Organization Name:PHYSICIANS WELLNESS CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-844-8188
Mailing Address - Street 1:618 US HIGHWAY 1
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4623
Mailing Address - Country:US
Mailing Address - Phone:561-844-8188
Mailing Address - Fax:
Practice Address - Street 1:618 US HIGHWAY 1
Practice Address - Street 2:SUITE 200
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4623
Practice Address - Country:US
Practice Address - Phone:561-844-8188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty