Provider Demographics
NPI:1790222362
Name:INTEGRATED HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATED HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SEAQUIST
Authorized Official - Last Name:MAZUROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-448-6042
Mailing Address - Street 1:4215 S GRAND CANYON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7172
Mailing Address - Country:US
Mailing Address - Phone:702-448-6042
Mailing Address - Fax:702-430-8970
Practice Address - Street 1:4215 S GRAND CANYON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-7172
Practice Address - Country:US
Practice Address - Phone:702-448-6042
Practice Address - Fax:702-430-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-20
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty