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General NPI Number Information
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NPI Number | 1780459842
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Entity Type | Organization
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Legal Business Name | WELL PELVIC HEALTH AND PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 202 LAWRENCE LN
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City | YREKA
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State | CA
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Zip | 96097-3341
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Country | US
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Telephone | 530-572-1566
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Fax | 153-028-5220
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Provider Business Mailing Address
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Address Line | 11239 BALL MTN LITTLE SHASTA RD
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City | MONTAGUE
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State | CA
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Zip | 96064-9682
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Country | US
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Telephone | 530-340-1490
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | LAURALEE WESSINGER WALLACE
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Credential | PT
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Telephone | 530-340-1490
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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 |
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License Number State |
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