Healthcare Provider Details

I. General information

NPI: 1558987669
Provider Name (Legal Business Name): WELLSPRING WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 08/03/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 DUNBAR RD
WARNER ROBINS GA
31093-3805
US

IV. Provider business mailing address

1101 DUNBAR RD
WARNER ROBINS GA
31093-3805
US

V. Phone/Fax

Practice location:
  • Phone: 478-508-1018
  • Fax:
Mailing address:
  • Phone: 478-785-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BETHANIE MAE BRYAN
Title or Position: PT
Credential: DPT
Phone: 478-508-1018