Provider Demographics
NPI:1023408135
Name:ADVANCE WELLNESS CENTERS OF MEMPHIS LLC
Entity type:Organization
Organization Name:ADVANCE WELLNESS CENTERS OF MEMPHIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-207-6074
Mailing Address - Street 1:2715 KIRBY RD
Mailing Address - Street 2:SUITE 15
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8238
Mailing Address - Country:US
Mailing Address - Phone:901-207-6074
Mailing Address - Fax:901-207-6086
Practice Address - Street 1:2715 KIRBY RD
Practice Address - Street 2:SUITE 15
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8238
Practice Address - Country:US
Practice Address - Phone:901-207-6074
Practice Address - Fax:901-207-6086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Group - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Multi-Specialty
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty