Provider Demographics
NPI:1821815440
Name:VITAL TREE PHYSICALS AND WELLNESS LLC
Entity type:Organization
Organization Name:VITAL TREE PHYSICALS AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:PUNO
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:630-338-9014
Mailing Address - Street 1:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-1055
Mailing Address - Country:US
Mailing Address - Phone:630-338-9014
Mailing Address - Fax:
Practice Address - Street 1:9786 ABERDEEN LN
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-2432
Practice Address - Country:US
Practice Address - Phone:630-338-9014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty