Provider Demographics
NPI:1558987669
Name:WELLSPRING WELLNESS CENTER
Entity Type:Organization
Organization Name:WELLSPRING WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:BETHANIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:478-508-1018
Mailing Address - Street 1:1101 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3805
Mailing Address - Country:US
Mailing Address - Phone:478-785-1024
Mailing Address - Fax:
Practice Address - Street 1:1101 DUNBAR RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3805
Practice Address - Country:US
Practice Address - Phone:478-508-1018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty