Healthcare Provider Details

I. General information

NPI: 1881378024
Provider Name (Legal Business Name): CONCIERGE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 LORDS HILL DR
FOUNTAIN CO
80817-6609
US

IV. Provider business mailing address

1315 LORDS HILL DR
FOUNTAIN CO
80817-6609
US

V. Phone/Fax

Practice location:
  • Phone: 817-944-6190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN WADE
Title or Position: OWNER
Credential: PT
Phone: 817-944-6190