Provider Demographics
NPI:1750727400
Name:PHYSICAL THERAPY AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TISCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:305-779-2427
Mailing Address - Street 1:7800 S RED RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5543
Mailing Address - Country:US
Mailing Address - Phone:305-779-2427
Mailing Address - Fax:
Practice Address - Street 1:7800 S RED RD STE 105
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5543
Practice Address - Country:US
Practice Address - Phone:305-779-2427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty