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General NPI Number Information
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NPI Number | 1376249698
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Entity Type | Organization
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Legal Business Name | WILD ROOTS WELLNESS INC.
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 45 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2422
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Country | US
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Telephone | 631-740-9595
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2422
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Country | US
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Telephone | 631-740-9595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SARA GALLITTO
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Credential |
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Telephone | 631-655-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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