Provider Demographics
NPI:1396416616
Name:WELLNESS ON WHEELS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:WELLNESS ON WHEELS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:240-447-5226
Mailing Address - Street 1:933 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7577
Mailing Address - Country:US
Mailing Address - Phone:240-447-5226
Mailing Address - Fax:
Practice Address - Street 1:933 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7577
Practice Address - Country:US
Practice Address - Phone:240-447-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy