NPIMap

Organization Active NPI

Wellness by Physicians Inc

  • Physical Medicine & Rehabilitation Physician
  • Port Charlotte, FL
National Provider Identifier
1699296087
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
WELLNESS BY PHYSICIANS INC
Doing business as
Physicians Rehabilitation
Practice address
3417 Tamiami TRL Ste a
Port Charlotte, FL 33952-8158
Phone
(239) 768-6396
Fax
(239) 204-3000
NPI assigned
Jul 6, 2017
Organization subpart
Yes
Parent organization
WELLNESS BY PHYSICIANS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
George Ghanem
Title
Ceo
Phone
(239) 768-6396

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

3417 Tamiami TRL Ste a
Port Charlotte, FL 33952-8158

Mailing address

6150 Diamond Centre CT BLDG 100
Fort Myers, FL 33912-4367
Phone (239) 768-6396

Other names 1

  • Physicians Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170726000706 FL DME Supplier - Physician - General PracticeDME Supplier - Independently-Practicing Physical Therapist 4688966260 Practice locations: Port Charlotte, FL

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Wellness by Physicians Inc4 organizations share this tax ID, including this one
Part of
Wellness by Physicians Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1699296087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6150 DIAMOND CENTRE CT BLDG 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124367",
            "telephone_number": "239-768-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 TAMIAMI TRL STE A",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528158",
            "telephone_number": "239-768-6396",
            "fax_number": "239-204-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS BY PHYSICIANS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLNESS BY PHYSICIANS INC",
        "enumeration_date": "2017-07-06",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A",
        "authorized_official_last_name": "GHANEM",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "239-768-6396"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physicians Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Charlotte, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.