Provider Demographics
NPI:1578863833
Name:WELLNESS PRACTICE OF PITTSBURGH, P.C.
Entity Type:Organization
Organization Name:WELLNESS PRACTICE OF PITTSBURGH, P.C.
Other - Org Name:BODYLOGICMD OF PITTSBURGH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-441-0531
Mailing Address - Street 1:681 ANDERSEN DR
Mailing Address - Street 2:STE 301
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2766
Mailing Address - Country:US
Mailing Address - Phone:866-441-0531
Mailing Address - Fax:
Practice Address - Street 1:681 ANDERSEN DR
Practice Address - Street 2:STE 301
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-2766
Practice Address - Country:US
Practice Address - Phone:866-441-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033145E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty