Provider Demographics
NPI:1265111496
Name:DR. PHYSIO THERAPY & WELLNESS
Entity type:Organization
Organization Name:DR. PHYSIO THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENISSON
Authorized Official - Middle Name:MELO
Authorized Official - Last Name:CARNEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:954-369-5787
Mailing Address - Street 1:3205 S FEDERAL HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3266
Mailing Address - Country:US
Mailing Address - Phone:954-369-5787
Mailing Address - Fax:954-206-7733
Practice Address - Street 1:3205 S FEDERAL HWY STE 8
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3266
Practice Address - Country:US
Practice Address - Phone:954-369-5787
Practice Address - Fax:954-206-7733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy