Provider Demographics
NPI:1548859192
Name:WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) INC.
Entity type:Organization
Organization Name:WALK ON WATER MINISTRIES OF CENTRAL FLORIDA (WOW) INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS HEALTH AND HUMAN
Authorized Official - Phone:321-412-8057
Mailing Address - Street 1:3380 N TROPICAL TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8221
Mailing Address - Country:US
Mailing Address - Phone:321-412-8057
Mailing Address - Fax:
Practice Address - Street 1:3330 PERKINSON LN MERRITT ISLAND FL 32953
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3295
Practice Address - Country:US
Practice Address - Phone:321-412-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty