Healthcare Provider Details

I. General information

NPI: 1689480527
Provider Name (Legal Business Name): FLY FREE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S 2ND ST
SHELTON WA
98584-3576
US

IV. Provider business mailing address

22 E CHERRY PARK
SHELTON WA
98584-9161
US

V. Phone/Fax

Practice location:
  • Phone: 360-529-7619
  • Fax:
Mailing address:
  • Phone: 360-529-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MORGAN B HODGSON
Title or Position: OWNER
Credential:
Phone: 360-529-7619