Provider Demographics
NPI:1518331198
Name:WELLNESS WORKS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:WELLNESS WORKS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-0670
Mailing Address - Street 1:404 BRUNN SCHOOL RD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1102
Mailing Address - Country:US
Mailing Address - Phone:505-983-0670
Mailing Address - Fax:505-983-0118
Practice Address - Street 1:404 BRUNN SCHOOL RD STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1102
Practice Address - Country:US
Practice Address - Phone:505-983-0670
Practice Address - Fax:505-983-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1073575031OtherNPI TYPE 1