Provider Demographics
NPI:1336357169
Name:ROCKWALL WELLNESS GROUP, INC.
Entity Type:Organization
Organization Name:ROCKWALL WELLNESS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:S
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:972-722-6192
Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SOUTE 205
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-722-6192
Mailing Address - Fax:214-771-0119
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SOUTE 205
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-722-6192
Practice Address - Fax:214-771-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)