Healthcare Provider Details

I. General information

NPI: 1780088559
Provider Name (Legal Business Name): ACCESS TO WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TABERNASH LANE - OR - 640 SHERMAN ST. #J
RIDGWAY CO
81432
US

IV. Provider business mailing address

2233 E MAIN ST
MONTROSE CO
81401-3831
US

V. Phone/Fax

Practice location:
  • Phone: 970-318-8690
  • Fax:
Mailing address:
  • Phone: 970-765-0818
  • Fax: 970-497-8410

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: KERRY G WILSON
Title or Position: OWNER
Credential: PT
Phone: 970-318-8690