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NPI Code Detail

MEDICARE: MY WELLNESS TEAM LLC

MEDICARE: MY WELLNESS TEAM 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
1225X00000XOccupational Therapist
2235Z00000XSpeech-Language Pathologist
3225100000XPhysical Therapist

General Provider Information

NPI Number : 1619651767
Entity Type Code : Organization
Provider Name (Legal Business Name) : MY WELLNESS TEAM LLC
Provider Business Mailing Address
First Line : 911 E 86TH ST
Second Line : SUITE 103
City : INDIANAPOLIS
State : IN
Zip : 46240
Country : US
Telephone Number : 812-267-2841
Fax Number :
Provider Business Practice Location Address
First Line : 4916 N BEND RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45211-2360
Country : US
Telephone Number : 317-750-1890
Fax Number :
Authorized Official
Title or Position : BUSINESS ADMINISTRATOR
Name : MRS. ANNE ROBERTSON
Credential :
Telephone Number : 812-267-2841
Provider Enumeration Date : 06/09/2023
Last Update Date : 09/25/2023

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Directions to “MY WELLNESS TEAM LLC ” Practice Location

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