Healthcare Provider Details

I. General information

NPI: 1598379729
Provider Name (Legal Business Name): WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OKATIE CENTER BOULEVARD NORTH
OKATIE SC
29909
US

IV. Provider business mailing address

100 OKATIE CENTER BOULEVARD NORTH
OKATIE SC
29909
US

V. Phone/Fax

Practice location:
  • Phone: 843-547-4058
  • Fax: 843-705-7411
Mailing address:
  • Phone: 843-547-4058
  • Fax: 843-705-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRAIG WEYER
Title or Position: OWNER/CEO
Credential: DPT
Phone: 843-547-4058