Provider Demographics
NPI:1427559079
Name:INSPIRED WELLNESS
Entity Type:Organization
Organization Name:INSPIRED WELLNESS
Other - Org Name:INSPIRED WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDORTHIST
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-833-0053
Mailing Address - Street 1:3645 CALDER AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5027
Mailing Address - Country:US
Mailing Address - Phone:409-833-0053
Mailing Address - Fax:409-833-0671
Practice Address - Street 1:3645 CALDER AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-5027
Practice Address - Country:US
Practice Address - Phone:409-833-0053
Practice Address - Fax:409-833-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid