Provider Demographics
NPI:1043870231
Name:REHAB AND WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:REHAB AND WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOIZUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-387-9787
Mailing Address - Street 1:1090 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501
Mailing Address - Country:US
Mailing Address - Phone:205-387-9787
Mailing Address - Fax:205-544-2909
Practice Address - Street 1:234 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150
Practice Address - Country:US
Practice Address - Phone:256-249-5500
Practice Address - Fax:256-249-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty