Provider Demographics
NPI:1700470168
Name:NEURO LOGIC REHABILITATION AND WELLNESS
Entity Type:Organization
Organization Name:NEURO LOGIC REHABILITATION AND WELLNESS
Other - Org Name:NEURO LOGIC REHABILITATION AND WELLNESS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-502-5971
Mailing Address - Street 1:114 SUNBIRD CLIFFS LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-8013
Mailing Address - Country:US
Mailing Address - Phone:847-502-5971
Mailing Address - Fax:719-691-7994
Practice Address - Street 1:114 SUNBIRD CLIFFS LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-8013
Practice Address - Country:US
Practice Address - Phone:847-502-5971
Practice Address - Fax:719-691-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy