Provider Demographics
NPI:1821597469
Name:ST JUDE WELLNESS PLLC
Entity Type:Organization
Organization Name:ST JUDE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LIM
Authorized Official - Last Name:CASIPIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:979-317-3754
Mailing Address - Street 1:2245 S ISABELLA RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2051
Mailing Address - Country:US
Mailing Address - Phone:979-317-3754
Mailing Address - Fax:
Practice Address - Street 1:2245 S ISABELLA RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2051
Practice Address - Country:US
Practice Address - Phone:979-317-3754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy