Provider Demographics
NPI:1942397989
Name:APPALACHIAN WELLNESS CENTER LTD
Entity Type:Organization
Organization Name:APPALACHIAN WELLNESS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALTIZER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:276-964-4018
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609
Mailing Address - Country:US
Mailing Address - Phone:276-964-4018
Mailing Address - Fax:276-964-2534
Practice Address - Street 1:177 WELLNESS DRIVE
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-964-4018
Practice Address - Fax:276-964-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
226755OtherBC
VA496611Medicare ID - Type Unspecified