Provider Demographics
NPI:1679123582
Name:RESILIENCE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:RESILIENCE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:RESILIENCE PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:413-789-0752
Mailing Address - Street 1:470 SHOEMAKER LANE
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3620
Mailing Address - Country:US
Mailing Address - Phone:413-789-0752
Mailing Address - Fax:413-789-8140
Practice Address - Street 1:470 SHOEMAKER LANE
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3620
Practice Address - Country:US
Practice Address - Phone:413-789-0752
Practice Address - Fax:413-789-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1902454598OtherINDIVIDUAL NPI