Provider Demographics
NPI:1851170260
Name:WELLNESS 2 SHAPE LLC
Entity Type:Organization
Organization Name:WELLNESS 2 SHAPE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:GAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBE EBOT
Authorized Official - Suffix:
Authorized Official - Credentials:EXERCISE AND WELLNES
Authorized Official - Phone:602-334-8232
Mailing Address - Street 1:450 N EUCALYPTUS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8257
Mailing Address - Country:US
Mailing Address - Phone:602-334-8232
Mailing Address - Fax:602-838-8867
Practice Address - Street 1:450 N EUCALYPTUS PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8257
Practice Address - Country:US
Practice Address - Phone:602-334-8232
Practice Address - Fax:602-838-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty