Provider Demographics
NPI:1912645201
Name:ROAD TO WELLNESS, LLC
Entity Type:Organization
Organization Name:ROAD TO WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-301-6311
Mailing Address - Street 1:3167 LAUDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7801
Mailing Address - Country:US
Mailing Address - Phone:804-991-4600
Mailing Address - Fax:804-718-0062
Practice Address - Street 1:3167 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-7801
Practice Address - Country:US
Practice Address - Phone:804-991-4600
Practice Address - Fax:804-718-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty