Provider Demographics
NPI:1568656403
Name:WELLNESS MATTERS PC
Entity Type:Organization
Organization Name:WELLNESS MATTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CULLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:512-275-0282
Mailing Address - Street 1:11009 MAELIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-2051
Mailing Address - Country:US
Mailing Address - Phone:512-275-0282
Mailing Address - Fax:972-459-3418
Practice Address - Street 1:11009 MAELIN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-2051
Practice Address - Country:US
Practice Address - Phone:512-275-0282
Practice Address - Fax:972-459-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1130250261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0038HCOtherBCBS GROUP
TX0038HCOtherBCBS GROUP