Provider Demographics
NPI:1538117791
Name:WELLNESS AND ERGONOMIC SOLUTIONS
Entity Type:Organization
Organization Name:WELLNESS AND ERGONOMIC SOLUTIONS
Other - Org Name:THERAPY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:CHAMBERS-GOOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:919-603-3833
Mailing Address - Street 1:912 COLLEGE ST
Mailing Address - Street 2:P.O. BOX 1556
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2645
Mailing Address - Country:US
Mailing Address - Phone:919-603-3833
Mailing Address - Fax:919-603-5833
Practice Address - Street 1:912 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2645
Practice Address - Country:US
Practice Address - Phone:919-603-3833
Practice Address - Fax:919-603-5833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014WFOtherBCBS
NC7211427Medicaid
NC2500557Medicare ID - Type Unspecified