MEDICARE: WELNUFIT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	TX
2	261QR0400X	Rehabilitation Clinic/Center
3	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1891182598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELNUFIT LLC

Provider Business Mailing Address
First Line	:	4000 INNOVATOR DR UNIT 19102
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-3897
Country	:	US
Telephone Number	:	972-426-6809
Fax Number	:	972-426-6809

Provider Business Practice Location Address
First Line	:	132 SOUTHWOOD DR
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-2826
Country	:	US
Telephone Number	:	800-680-4039
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TONYA R BUTLER
Credential	:
Telephone Number	:	800-680-4039

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	04/20/2015

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Directions to “WELNUFIT LLC ” Practice Location

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