=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174954085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALCHEMY WELLNESS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2013
-----------------------------------------------------
Last Update Date | 12/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5428 WILLIAMS DR
-----------------------------------------------------
City | ROSCOE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61073-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-703-3384
-----------------------------------------------------
Fax | 814-623-1400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5428 WILLIAMS DR
-----------------------------------------------------
City | ROSCOE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61073-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-703-3384
-----------------------------------------------------
Fax | 814-623-1400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. RACHEL MICHELLE BIXBY
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 815-703-3384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 070007245
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------