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General NPI Number Information
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NPI Number | 1184489957
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Entity Type | Organization
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Legal Business Name | WOLVERTON WELLNESS, LLC
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 8500 SKYLINE WAY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2266
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Country | US
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Telephone | 334-798-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 8500 SKYLINE WAY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2266
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Country | US
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Telephone | 334-798-5757
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON D WOLVERTON
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Credential | DPT, MOTR/L
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Telephone | 334-798-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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