Provider Demographics
NPI:1639946478
Name:DYNAMIC WELLNESS STUDIO
Entity Type:Organization
Organization Name:DYNAMIC WELLNESS STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:330-524-6491
Mailing Address - Street 1:12464 LAUREL HILL RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9380
Mailing Address - Country:US
Mailing Address - Phone:330-524-6491
Mailing Address - Fax:
Practice Address - Street 1:409 S 22ND ST STE 5
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1575
Practice Address - Country:US
Practice Address - Phone:740-564-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty