Provider Demographics
NPI:1083027783
Name:WELLNESS REHAB CENTER LLC
Entity type:Organization
Organization Name:WELLNESS REHAB CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-855-8237
Mailing Address - Street 1:11920 VISTA DEL SOL DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6118
Mailing Address - Country:US
Mailing Address - Phone:915-855-8237
Mailing Address - Fax:915-751-1660
Practice Address - Street 1:11920 VISTA DEL SOL DR BLDG B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6118
Practice Address - Country:US
Practice Address - Phone:915-855-8237
Practice Address - Fax:915-751-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 261QR0400X, 225100000X
TX1074227261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation