Provider Demographics
NPI:1487170239
Name:CONCIERGE PHYSICAL THERAPY AND WELLNESS, LLC
Entity type:Organization
Organization Name:CONCIERGE PHYSICAL THERAPY AND WELLNESS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:513-443-4613
Mailing Address - Street 1:5475 SURREY CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1149
Mailing Address - Country:US
Mailing Address - Phone:276-870-2221
Mailing Address - Fax:
Practice Address - Street 1:5475 SURREY CT
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1149
Practice Address - Country:US
Practice Address - Phone:276-870-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013278261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy