Provider Demographics
NPI:1881201325
Name:REFINED WELLNESS AND PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REFINED WELLNESS AND PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-440-7977
Mailing Address - Street 1:21 QUARRY LN UNIT 8522
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5042
Mailing Address - Country:US
Mailing Address - Phone:315-440-7977
Mailing Address - Fax:
Practice Address - Street 1:21 QUARRY LN UNIT 8522
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5042
Practice Address - Country:US
Practice Address - Phone:315-440-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty