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General NPI Number Information
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NPI Number | 1790295566
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Entity Type | Organization
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Legal Business Name | EASTWAY WELLNESS LLC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 11 VANDERBILT AVE
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City | NORWOOD
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State | MA
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Zip | 02062-5056
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Country | US
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Telephone | 781-688-0138
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Fax | 781-269-5613
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Provider Business Mailing Address
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Address Line | 11 VANDERBILT AVE 210
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City | NORWOOD
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State | MA
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Zip | 02062-5056
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Country | US
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Telephone | 781-688-0138
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Fax | 781-269-5613
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Authorized Official
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Title or Position | MANAGER
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Name | YI LUO
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Credential | LAC
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Telephone | 781-688-0138
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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 | 22813
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License Number State | MA
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