Provider Demographics
NPI:1598001307
Name:WELLNESS PHYSICAL THERAPY OF DIAMONDHEAD
Entity Type:Organization
Organization Name:WELLNESS PHYSICAL THERAPY OF DIAMONDHEAD
Other - Org Name:WELLNESS PT OF DIAMONDHEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:MURRET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-649-6577
Mailing Address - Street 1:1311 GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3015
Mailing Address - Country:US
Mailing Address - Phone:985-649-6577
Mailing Address - Fax:985-649-7615
Practice Address - Street 1:1053 TINA LADNER VIC FAYE RD
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-8920
Practice Address - Country:US
Practice Address - Phone:985-649-6577
Practice Address - Fax:985-649-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy