Provider Demographics
NPI:1083909030
Name:WBT THERAPY - WORKS LLC
Entity Type:Organization
Organization Name:WBT THERAPY - WORKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WALLENDA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED,CCC-SLP
Authorized Official - Phone:678-322-8255
Mailing Address - Street 1:3932 HERRON LN SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1599
Mailing Address - Country:US
Mailing Address - Phone:678-322-8255
Mailing Address - Fax:888-806-8549
Practice Address - Street 1:1514 CLEVELAND AVE
Practice Address - Street 2:STE 101 B
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6965
Practice Address - Country:US
Practice Address - Phone:678-322-8255
Practice Address - Fax:888-806-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116207BMedicaid