Healthcare Provider Details

I. General information

NPI: 1184152563
Provider Name (Legal Business Name): WELLNESS WALK-IN TUBS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N ACADEMY BLVD STE 102
COLORADO SPRINGS CO
80909-6621
US

IV. Provider business mailing address

320 N ACADEMY BLVD STE 102
COLORADO SPRINGS CO
80909-6621
US

V. Phone/Fax

Practice location:
  • Phone: 719-375-3044
  • Fax: 719-452-3858
Mailing address:
  • Phone: 719-375-3044
  • Fax: 719-452-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberA170230
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2017126975100CL
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number2017126972000SL
License Number StateCO

VIII. Authorized Official

Name: MR. SEAN MICHAEL WELCH
Title or Position: OWNER
Credential:
Phone: 719-375-3044