Healthcare Provider Details

I. General information

NPI: 1245056365
Provider Name (Legal Business Name): FLOURISH HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W US HIGHWAY 2
GRAND RAPIDS MN
55744-4736
US

IV. Provider business mailing address

1020 N POKEGAMA AVE
GRAND RAPIDS MN
55744-2444
US

V. Phone/Fax

Practice location:
  • Phone: 218-969-8226
  • Fax:
Mailing address:
  • Phone: 218-969-8226
  • Fax:

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: LISA L WYLAND
Title or Position: PHYSICAL THERAPIST
Credential: PT, MOMT
Phone: 218-969-8226