Healthcare Provider Details

I. General information

NPI: 1871858456
Provider Name (Legal Business Name): EPOCH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1759 ELMBURN LN
HEBRON KY
41048-6712
US

IV. Provider business mailing address

1759 ELMBURN LN
HEBRON KY
41048-6712
US

V. Phone/Fax

Practice location:
  • Phone: 513-446-1798
  • Fax:
Mailing address:
  • Phone: 513-446-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number7553
License Number StateOH

VIII. Authorized Official

Name: KEITH COLLINS
Title or Position: DIRECTOR
Credential: MS
Phone: 513-446-1798