Provider Demographics
NPI:1689331571
Name:WELL ROOTED MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:WELL ROOTED MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MAULELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-573-8382
Mailing Address - Street 1:5 FAIRLAWN DR STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1290
Mailing Address - Country:US
Mailing Address - Phone:917-573-8382
Mailing Address - Fax:
Practice Address - Street 1:5 FAIRLAWN DR STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:NY
Practice Address - Zip Code:10992-1290
Practice Address - Country:US
Practice Address - Phone:917-573-8382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty