Provider Demographics
NPI:1730480633
Name:NEURO WELLNESS
Entity Type:Organization
Organization Name:NEURO WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:INBAR-HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:510-845-5537
Mailing Address - Street 1:1356 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1711
Mailing Address - Country:US
Mailing Address - Phone:510-845-5537
Mailing Address - Fax:510-845-5537
Practice Address - Street 1:1356 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-1711
Practice Address - Country:US
Practice Address - Phone:510-845-5537
Practice Address - Fax:510-845-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT175072251N0400X
CAOT5695225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Single Specialty