Provider Demographics
NPI:1295894525
Name:WELLNESSONE OF BOARDMAN
Entity type:Organization
Organization Name:WELLNESSONE OF BOARDMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHETSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-543-2097
Mailing Address - Street 1:11800 E WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:OH
Mailing Address - Zip Code:44021
Mailing Address - Country:US
Mailing Address - Phone:440-543-2099
Mailing Address - Fax:440-543-2085
Practice Address - Street 1:843 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:440-543-2097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH82002519111N00000X
OH3268111N00000X
OH2435111N00000X
OH3612111N00000X
OHPT011126225100000X
OHPT011128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty