Healthcare Provider Details

I. General information

NPI: 1164413902
Provider Name (Legal Business Name): WELLNESS ONE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 BLUE RIDGE RD SUITE 100
RALEIGH NC
27607-6480
US

IV. Provider business mailing address

3528 WADE AVE #139
RALEIGH NC
27607-4048
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-5954
  • Fax: 919-859-9444
Mailing address:
  • Phone: 919-782-5954
  • Fax: 919-859-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE SYDNOR
Title or Position: OWNER
Credential: OT
Phone: 919-782-5954