Provider Demographics
NPI:1457946980
Name:DRVN PHYSICAL THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:DRVN PHYSICAL THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MUCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:386-315-2672
Mailing Address - Street 1:19 HUNT MASTER CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2442
Mailing Address - Country:US
Mailing Address - Phone:386-315-2672
Mailing Address - Fax:
Practice Address - Street 1:19 HUNT MASTER CT
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2442
Practice Address - Country:US
Practice Address - Phone:386-315-2672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty