Provider Demographics
NPI:1548947872
Name:INTERNATIONAL OKINAWAN KARATE ACADEMY & WELLNESS
Entity type:Organization
Organization Name:INTERNATIONAL OKINAWAN KARATE ACADEMY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHT/FACILITATOR/WELLNESS COACH
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:III
Authorized Official - Credentials:CHIEF INSTRUCTOR
Authorized Official - Phone:480-925-1393
Mailing Address - Street 1:2902 W SWEETWATER AVE APT 1036
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1390
Mailing Address - Country:US
Mailing Address - Phone:888-516-1966
Mailing Address - Fax:
Practice Address - Street 1:1121 W BELL RD STE 373
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-3516
Practice Address - Country:US
Practice Address - Phone:888-516-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No226000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreational Therapist AssistantGroup - Multi-Specialty