Provider Demographics
NPI:1649600982
Name:ADVANCE WELLNESS & EDUCATION CENTER,LLC
Entity Type:Organization
Organization Name:ADVANCE WELLNESS & EDUCATION CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAGGIAI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-272-3844
Mailing Address - Street 1:222 MOOREHEAD RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-8670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 S PIKE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9283
Practice Address - Country:US
Practice Address - Phone:724-272-3844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2014-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X, 225X00000X
PAPT007479L225100000X
PASL007570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty