Provider Demographics
NPI:1376217786
Name:FULL RANGE WELLNESS
Entity Type:Organization
Organization Name:FULL RANGE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:248-595-1500
Mailing Address - Street 1:799 N HOLBROOK ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1407
Mailing Address - Country:US
Mailing Address - Phone:248-595-1500
Mailing Address - Fax:
Practice Address - Street 1:3967 IVERNESS LN
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1712
Practice Address - Country:US
Practice Address - Phone:248-595-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy