Healthcare Provider Details

I. General information

NPI: 1568200053
Provider Name (Legal Business Name): THE COMMUNITY WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MAIN ST STE A
LAKE MILLS IA
50450-1470
US

IV. Provider business mailing address

105 W MAIN ST STE A
LAKE MILLS IA
50450-1470
US

V. Phone/Fax

Practice location:
  • Phone: 319-432-5089
  • Fax:
Mailing address:
  • Phone: 319-432-5089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMY STUCKY
Title or Position: OWNER/FOUNDER
Credential: CMMT, LMT, HP
Phone: 319-432-5089