Healthcare Provider Details

I. General information

NPI: 1649600982
Provider Name (Legal Business Name): ADVANCE WELLNESS & EDUCATION CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 04/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S PIKE RD SUITE 200
SARVER PA
16055-9283
US

IV. Provider business mailing address

222 MOOREHEAD RD
SARVER PA
16055-8670
US

V. Phone/Fax

Practice location:
  • Phone: 724-272-3844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007479L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL007570
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA TRAGGIAI
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: P.T.
Phone: 724-272-3844