Provider Demographics
NPI:1861795585
Name:WELLNESS AND REHAB SPECIALISTS LLC
Entity type:Organization
Organization Name:WELLNESS AND REHAB SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-206-6240
Mailing Address - Street 1:2531 SW FONDURA RD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2773
Mailing Address - Country:US
Mailing Address - Phone:772-348-4272
Mailing Address - Fax:772-348-4612
Practice Address - Street 1:2531 SW FONDURA RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2773
Practice Address - Country:US
Practice Address - Phone:772-348-4272
Practice Address - Fax:772-348-4612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty