Provider Demographics
NPI:1851141873
Name:RECLAIM THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:RECLAIM THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOU ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:928-201-4055
Mailing Address - Street 1:10019 WICKER PARK PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-1109
Mailing Address - Country:US
Mailing Address - Phone:928-201-4055
Mailing Address - Fax:
Practice Address - Street 1:10019 WICKER PARK PL
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-1109
Practice Address - Country:US
Practice Address - Phone:928-201-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy