Healthcare Provider Details

I. General information

NPI: 1083961577
Provider Name (Legal Business Name): ACTION THERAPY & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E WORTHY ROAD BLDG IV
GONZALES LA
70737
US

IV. Provider business mailing address

211 E WORTHY ROAD BLDG IV
GONZALES LA
70737
US

V. Phone/Fax

Practice location:
  • Phone: 255-644-7044
  • Fax: 225-644-4414
Mailing address:
  • Phone: 255-644-7044
  • Fax: 225-644-4414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRIDGET PETRIE
Title or Position: OWNER
Credential:
Phone: 225-644-7044