Provider Demographics
NPI:1790295566
Name:EASTWAY WELLNESS LLC
Entity Type:Organization
Organization Name:EASTWAY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:781-688-0138
Mailing Address - Street 1:11 VANDERBILT AVE
Mailing Address - Street 2:210
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5056
Mailing Address - Country:US
Mailing Address - Phone:781-688-0138
Mailing Address - Fax:781-269-5613
Practice Address - Street 1:11 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5056
Practice Address - Country:US
Practice Address - Phone:781-688-0138
Practice Address - Fax:781-269-5613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTWAY WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22813OtherPHYSICAL THERAPY