Provider Demographics
NPI:1548585623
Name:WELLNESS REHAB CENTER
Entity Type:Organization
Organization Name:WELLNESS REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE THERAPY
Authorized Official - Prefix:MISS
Authorized Official - First Name:QIAOLING
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:KUANG
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:917-379-7532
Mailing Address - Street 1:17227 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3323
Mailing Address - Country:US
Mailing Address - Phone:718-978-3389
Mailing Address - Fax:
Practice Address - Street 1:17227 128TH AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3323
Practice Address - Country:US
Practice Address - Phone:718-978-3389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)