Provider Demographics
NPI:1871024059
Name:ISLAND WELLNESS CENTER
Entity Type:Organization
Organization Name:ISLAND WELLNESS CENTER
Other - Org Name:AMY C BIENVENU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BIENVENU
Authorized Official - Suffix:
Authorized Official - Credentials:CR,LMP
Authorized Official - Phone:360-472-1356
Mailing Address - Street 1:PO BOX 1796
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-1796
Mailing Address - Country:US
Mailing Address - Phone:360-472-1356
Mailing Address - Fax:
Practice Address - Street 1:470 SPRING ST STE 103
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7230
Practice Address - Country:US
Practice Address - Phone:360-472-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6888172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty