Provider Demographics
NPI:1164176079
Name:NURTURING WELLNESS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NURTURING WELLNESS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYHELEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:401-379-9971
Mailing Address - Street 1:1560 STONY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-2914
Mailing Address - Country:US
Mailing Address - Phone:401-379-9971
Mailing Address - Fax:
Practice Address - Street 1:1560 STONY LN
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-2914
Practice Address - Country:US
Practice Address - Phone:401-379-9971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy