Provider Demographics
NPI:1891253506
Name:WELLVOLUTION LLC
Entity Type:Organization
Organization Name:WELLVOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-306-5511
Mailing Address - Street 1:1097 E MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5718
Mailing Address - Country:US
Mailing Address - Phone:530-306-5511
Mailing Address - Fax:
Practice Address - Street 1:1097 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5718
Practice Address - Country:US
Practice Address - Phone:530-306-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy