Provider Demographics
NPI:1720107048
Name:WELLNESS IN SLEEP PA
Entity Type:Organization
Organization Name:WELLNESS IN SLEEP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-820-0427
Mailing Address - Street 1:908 W TERRELL AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3034
Mailing Address - Country:US
Mailing Address - Phone:817-820-0427
Mailing Address - Fax:271-820-0430
Practice Address - Street 1:908 W TERRELL AVE N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3034
Practice Address - Country:US
Practice Address - Phone:817-820-0427
Practice Address - Fax:271-820-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568401594OtherNPI