Provider Demographics
NPI:1134176852
Name:WELLNESS WORKS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:WELLNESS WORKS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:PT MTC CFMT
Authorized Official - Phone:410-902-5997
Mailing Address - Street 1:10207 SOUTH DOLFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3607
Mailing Address - Country:US
Mailing Address - Phone:410-902-5997
Mailing Address - Fax:410-902-5776
Practice Address - Street 1:10207 SOUTH DOLFIELD ROAD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3607
Practice Address - Country:US
Practice Address - Phone:410-902-5997
Practice Address - Fax:410-902-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
N183OtherCARE FIRST BCBS
637CWEOtherCARE FIRST BCBS
Q08284Medicare UPIN
N183OtherCARE FIRST BCBS