Healthcare Provider Details

I. General information

NPI: 1801452446
Provider Name (Legal Business Name): URBANA WELLNESS ONLINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 PINEVILLE MATTHEWS RD STE 5B
CHARLOTTE NC
28226-4076
US

IV. Provider business mailing address

1105 BERWICK CT
WAXHAW NC
28173-6547
US

V. Phone/Fax

Practice location:
  • Phone: 707-706-0101
  • Fax:
Mailing address:
  • Phone: 704-840-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MAURICE LEE
Title or Position: MANAGER
Credential:
Phone: 704-840-7644