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General NPI Number Information
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NPI Number | 1467625848
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Entity Type | Organization
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Legal Business Name | ALL WELLNESS, LLC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 208 FLYNN AVE STUDIO 3A
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City | BURLINGTON
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State | VT
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Zip | 05401-5429
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Country | US
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Telephone | 802-863-9900
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Fax | 802-863-9922
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Provider Business Mailing Address
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Address Line | 208 FLYNN AVE STUDIO 3A
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City | BURLINGTON
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State | VT
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Zip | 05401-5429
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Country | US
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Telephone | 802-863-9900
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Fax | 802-863-9922
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/ CO-OWNER
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Name | LENA MARIA CANNIZZARO
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Credential | P.T.
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Telephone | 802-863-9900
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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 | 040-0003496
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License Number State | VT
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