Provider Demographics
NPI:1952280653
Name:LIVE FULLY NOW REHAB AND WELLNESS
Entity type:Organization
Organization Name:LIVE FULLY NOW REHAB AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHICKER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, COTA, MSOM
Authorized Official - Phone:862-244-5885
Mailing Address - Street 1:PO BOX 433
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-0433
Mailing Address - Country:US
Mailing Address - Phone:862-244-5885
Mailing Address - Fax:
Practice Address - Street 1:1001 COUNTY ROAD 517
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2730
Practice Address - Country:US
Practice Address - Phone:862-244-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty