Provider Demographics
NPI:1750056313
Name:WELLNESS ESSENTIALS CENTER LLC
Entity Type:Organization
Organization Name:WELLNESS ESSENTIALS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIJO
Authorized Official - Middle Name:GUZMAN
Authorized Official - Last Name:VOLLMAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:541-991-7151
Mailing Address - Street 1:625 HIGHWAY 101 # 272
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-7634
Mailing Address - Country:US
Mailing Address - Phone:541-991-1715
Mailing Address - Fax:
Practice Address - Street 1:4678 MITCHELL LOOP RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-8464
Practice Address - Country:US
Practice Address - Phone:541-991-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy