Provider Demographics
NPI:1356645741
Name:NORDIC REHAB @ WELLNESS
Entity Type:Organization
Organization Name:NORDIC REHAB @ WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-644-5803
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05444-0152
Mailing Address - Country:US
Mailing Address - Phone:802-644-5803
Mailing Address - Fax:802-644-2810
Practice Address - Street 1:272 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:VT
Practice Address - Zip Code:05444
Practice Address - Country:US
Practice Address - Phone:802-644-5803
Practice Address - Fax:802-644-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty