Provider Demographics
NPI:1811442007
Name:MILL POND INTEGRATIVE HEALTH AND WELLNESS CENTER
Entity type:Organization
Organization Name:MILL POND INTEGRATIVE HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-219-0617
Mailing Address - Street 1:3650 BOSTON RD
Mailing Address - Street 2:SUITE 188
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1569
Mailing Address - Country:US
Mailing Address - Phone:859-219-0617
Mailing Address - Fax:859-219-0622
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:SUITE 188
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:859-219-0617
Practice Address - Fax:859-219-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty