Provider Demographics
NPI:1770256091
Name:ENHANCED RECOVERY AND WELLNESS LLC
Entity Type:Organization
Organization Name:ENHANCED RECOVERY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:336-508-3881
Mailing Address - Street 1:6364 MARILEE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-8356
Mailing Address - Country:US
Mailing Address - Phone:719-203-2795
Mailing Address - Fax:719-239-3785
Practice Address - Street 1:6364 MARILEE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-8356
Practice Address - Country:US
Practice Address - Phone:719-203-2795
Practice Address - Fax:719-239-3785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy