Provider Demographics
NPI:1669821930
Name:WELLISTICS PHYSICAL THERAPY CENTER L3C
Entity Type:Organization
Organization Name:WELLISTICS PHYSICAL THERAPY CENTER L3C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-224-8400
Mailing Address - Street 1:4228 WILLIAMS BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2270
Mailing Address - Country:US
Mailing Address - Phone:504-224-8400
Mailing Address - Fax:504-272-0237
Practice Address - Street 1:4228 WILLIAMS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2270
Practice Address - Country:US
Practice Address - Phone:504-224-8400
Practice Address - Fax:504-272-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1669821930OtherPHYSICAL THERAPY
LA1861848954OtherPHYSICAL THERAPY