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General NPI Number Information
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NPI Number | 1457129587
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Entity Type | Organization
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Legal Business Name | PROJECT WELLNESS LLC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 3039 W PEORIA AVE STE 102
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City | PHOENIX
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State | AZ
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Zip | 85029-5212
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Country | US
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Telephone | 480-744-7491
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Fax | 833-450-5270
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Provider Business Mailing Address
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Address Line | 3039 W PEORIA AVE STE 102
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City | PHOENIX
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State | AZ
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Zip | 85029-5212
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Country | US
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Telephone | 480-744-7491
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Fax | 833-450-5270
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Authorized Official
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Title or Position | CEO
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Name | KEVIN CONBOY
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Credential | PA-C
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Telephone | 320-262-1954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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