Provider Demographics
NPI:1487346698
Name:RETREAT WELLNESS LLC
Entity type:Organization
Organization Name:RETREAT WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:717-669-1561
Mailing Address - Street 1:365 SYLVAN RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-9036
Mailing Address - Country:US
Mailing Address - Phone:717-669-1561
Mailing Address - Fax:
Practice Address - Street 1:365 SYLVAN RETREAT RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-9036
Practice Address - Country:US
Practice Address - Phone:717-669-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty