Basic Information
| Provider Information | |||||||||
| NPI: | 1013634799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WELLNESS CAFE PHYSICAL THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1292 QUANDT CT | ||||||||
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| City: | LAFAYETTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945492624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252165047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2770 PLEASANT HILL RD | ||||||||
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| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945232044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252165047 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2022 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZEGAROWSKI | ||||||||
| AuthorizedOfficialFirstName: | BEATA | ||||||||
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| AuthorizedOfficialTitleorPosition: | P.T. | ||||||||
| AuthorizedOfficialTelephone: | 9252165047 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.