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General NPI Number Information
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NPI Number | 1023834967
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Entity Type | Organization
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Legal Business Name | WILDFLOWER PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 970 FORT WAYNE AVE STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-4329
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Country | US
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Telephone | 906-282-8314
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 GOLFVIEW DR
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-6620
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Country | US
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Telephone | 906-282-8314
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIRANDA ROBLES
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Credential | PT, DPT
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Telephone | 111-111-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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