Provider Demographics
NPI: | 1255720660 |
---|---|
Name: | NEW DAY WELLNESS, LLC |
Entity type: | Organization |
Organization Name: | NEW DAY WELLNESS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | BRUCE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SACK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 352-493-2999 |
Mailing Address - Street 1: | 7701 SW 56TH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | GAINESVILLE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32608-4406 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 352-493-2999 |
Mailing Address - Fax: | 352-493-0026 |
Practice Address - Street 1: | 1315 NW 21ST AVE |
Practice Address - Street 2: | SUITE 3 |
Practice Address - City: | CHIEFLAND |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32626-1977 |
Practice Address - Country: | US |
Practice Address - Phone: | 352-493-2999 |
Practice Address - Fax: | 352-493-0026 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-01-22 |
Last Update Date: | 2015-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PT2095 | 225100000X |
FL | PT4102 | 2251G0304X |
FL | PT2449 | 2251N0400X |
FL | OT4234 | 225XE0001X, 225XG0600X, 225XN1300X, 225XP0019X, 225X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | Group - Multi-Specialty |
No | 225XG0600X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Gerontology | Group - Multi-Specialty |
No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | AB161 | Medicare PIN |