Healthcare Provider Details

I. General information

NPI: 1639714850
Provider Name (Legal Business Name): PUYALLUP WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 S MERIDIAN
PUYALLUP WA
98373-1402
US

IV. Provider business mailing address

2802 S MERIDIAN
PUYALLUP WA
98373-1402
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-5032
  • Fax: 253-845-0129
Mailing address:
  • Phone: 253-445-5032
  • Fax: 253-845-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY MUNDT
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 253-473-3733