Provider Demographics
NPI:1083961577
Name:ACTION THERAPY & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ACTION THERAPY & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-644-7044
Mailing Address - Street 1:211 E WORTHY ROAD
Mailing Address - Street 2:BLDG IV
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:255-644-7044
Mailing Address - Fax:225-644-4414
Practice Address - Street 1:211 E WORTHY ROAD
Practice Address - Street 2:BLDG IV
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:255-644-7044
Practice Address - Fax:225-644-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty