Provider Demographics
NPI:1922299338
Name:TOTAL WELLNESS INC
Entity Type:Organization
Organization Name:TOTAL WELLNESS INC
Other - Org Name:MARKETPLACE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPPAPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-684-2874
Mailing Address - Street 1:3191B MISSION INN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4138
Mailing Address - Country:US
Mailing Address - Phone:951-684-2874
Mailing Address - Fax:951-684-2980
Practice Address - Street 1:3191 MISSION INN AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4188
Practice Address - Country:US
Practice Address - Phone:951-376-3380
Practice Address - Fax:951-684-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12634261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27422ZMedicare PIN