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Organization
WELLNESS AND AESTHETICS INSTITUTE, PA
Active
Organization
WELLNESS AND AESTHETICS INSTITUTE, PA
Active
Other names
Wellness Metabolic Institute
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BEVERLY D KOTSANIS (CHIEF EXECUTIVE OFFICER)
(817) 481-6342
Entity
Organization
Contact information
Practice address
2020 W STATE HIGHWAY 114, SUITE 260, GRAPEVINE, TX 76051-8649
(817) 481-6342
(817) 442-4848
Mailing address
2020 W STATE HIGHWAY 114, SUITE 260, GRAPEVINE, TX 76051-8649
(817) 481-6342
(817) 442-4848
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
G5951
TX
207RX0202X
Medical Oncology Physician
G5951
TX
207Y00000X
Otolaryngology Physician
Primary
G5951
TX
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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