Healthcare Provider Details

I. General information

NPI: 1871002956
Provider Name (Legal Business Name): WELLNESS COACHES USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SKIPPACK PIKE STE 300
BLUE BELL PA
19422-1749
US

IV. Provider business mailing address

725 SKIPPACK PIKE STE 300
BLUE BELL PA
19422-1749
US

V. Phone/Fax

Practice location:
  • Phone: 215-628-4454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A PUTNAM
Title or Position: COO
Credential:
Phone: 215-628-4454