Provider Demographics
NPI:1720794522
Name:SOWALHEALTH INC
Entity Type:Organization
Organization Name:SOWALHEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETRUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-797-2711
Mailing Address - Street 1:9375 EMERALD COAST PKWY W STE 27A
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7222
Mailing Address - Country:US
Mailing Address - Phone:850-797-2711
Mailing Address - Fax:
Practice Address - Street 1:9375 EMERALD COAST PKWY W STE 27A
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7222
Practice Address - Country:US
Practice Address - Phone:850-797-2711
Practice Address - Fax:850-396-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center