| Physical Therapy Wellness Group | |
| 
					519 Sw Nagle Place Port Saint Lucie FL 34953  | |
| (772) 209-1183 | |
| Not Available | 
| Full Name | Physical Therapy Wellness Group | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 519 Sw Nagle Place, Port Saint Lucie, Florida | 
| Authorized Official Name and Position | Sperancia Anna White (PHYSICAL THERAPIST/OWNER) | 
| Authorized Official Contact | 7722091183 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Physical Therapy Wellness Group 10380 Sw Village Center Dr # 355 Port Saint Lucie FL 34987-1931 Ph: (772) 209-1183  | Physical Therapy Wellness Group 519 Sw Nagle Place Port Saint Lucie FL 34953 Ph: (772) 209-1183  | 
| NPI Number | 1023677630 | 
|---|---|
| Provider Enumeration Date | 06/07/2019 | 
| Last Update Date | 05/23/2020 | 
| Medicare PECOS PAC ID | 7810314853 | 
|---|---|
| Medicare Enrollment ID | O20200904000825 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1023677630 | NPI | - | NPPES | 
| 261Q00000X | Medicaid | FL | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary | 
| Provider Name | Sperancia Anna White | 
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice | 
| Provider Identifiers | NPI Number: 1750602462 PECOS PAC ID: 4981636610 Enrollment ID: I20200904001680  | 
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