Provider Demographics
NPI:1184054637
Name:VIRTUOUS WELLNESS CENTER
Entity type:Organization
Organization Name:VIRTUOUS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, LMT
Authorized Official - Phone:410-975-5343
Mailing Address - Street 1:273 PENINSULA FARM RD
Mailing Address - Street 2:BUILDING 2 SUITE C
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1012
Mailing Address - Country:US
Mailing Address - Phone:410-975-5343
Mailing Address - Fax:
Practice Address - Street 1:273 PENINSULA FARM RD
Practice Address - Street 2:BUILDING 2 SUITE C
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1012
Practice Address - Country:US
Practice Address - Phone:410-975-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16378225100000X
MDMO4549225700000X
MD17413225100000X
MDA2694225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty