=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922414473
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENERGY REHAB WELLNESS AND TRAINING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2014
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 177 CHAMPION DR # 100
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16803-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-238-3485
-----------------------------------------------------
Fax | 814-692-2272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 177 CHAMPION DR # 100
-----------------------------------------------------
City | STATE COLLEGE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16803-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-238-3485
-----------------------------------------------------
Fax | 814-692-2272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | NICOLE L MELLOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-238-3485
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT012059L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------