MEDICARE: THE WELLNESS INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134985658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELLNESS INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	8039 HOLLYGRAPE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4039
Country	:	US
Telephone Number	:	818-919-8873
Fax Number	:	254-307-9700

Provider Business Practice Location Address
First Line	:	8039 HOLLYGRAPE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4039
Country	:	US
Telephone Number	:	818-919-8873
Fax Number	:	254-307-9700

Authorized Official
Title or Position	:	OWNER
Name	:	ISABEL NORTHINGTON
Credential	:	PT/DPT, C/NDT,
Telephone Number	:	719-377-5688

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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