1760528129 NPI number — MS. PATRICIA WELLER L.M.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760528129 NPI number — MS. PATRICIA WELLER L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLER
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLNESS
Provider Other First Name:
BODY
Provider Other Middle Name:
AND SOUL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
INC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1760528129
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
784 US HIGHWAY 1
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
NORTH PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33408-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-625-3040
Provider Business Mailing Address Fax Number:
954-963-7169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
784 US HIGHWAY 1
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NORTH PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-625-3040
Provider Business Practice Location Address Fax Number:
954-963-7169
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA20136 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C7972 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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