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General NPI Number Information
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NPI Number | 1699858191
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Entity Type | Organization
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Legal Business Name | WELLSPRING THERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 10 S BROOK ST SUITE 2
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City | CLEVELAND
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State | GA
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Zip | 30528-1151
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Country | US
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Telephone | 706-348-2004
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Fax | 706-348-2014
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Provider Business Mailing Address
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Address Line | 10 S. BROOK ST. STE. 2
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City | CLEVELAND
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State | GA
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Zip | 30528-0014
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Country | US
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Telephone | 706-348-2004
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Fax | 706-348-2014
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GRAYSON GENTZEL
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Credential | MPT
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Telephone | 706-348-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 624036001
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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