Provider Demographics
NPI:1669879011
Name:WELLBODY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:WELLBODY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GM
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-360-5016
Mailing Address - Street 1:951 PRIM AVE
Mailing Address - Street 2:
Mailing Address - City:GRACEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32440-2505
Mailing Address - Country:US
Mailing Address - Phone:850-209-3007
Mailing Address - Fax:850-360-5024
Practice Address - Street 1:951 PRIM AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:GRACEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32440-2505
Practice Address - Country:US
Practice Address - Phone:850-209-3007
Practice Address - Fax:850-360-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty