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BACK TO WELLNESS PLC NPI 1912211210

NPI Profile

NPI: 1912211210
Provider Name: BACK TO WELLNESS PLC
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
368 DORSET ST STE 3
SOUTH BURLINGTON, VT
ZIP 05403
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Phone: (802) 864-4959

BACK TO WELLNESS PLC is a cliniccenter in South Burlington, VT. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). BACK TO WELLNESS PLC NPI is 1912211210. The provider is registered as an organization entity type.

The provider's business location address is:

368 DORSET ST STE 3
SOUTH BURLINGTON, VT
ZIP 05403-236
Phone: (802) 864-4959
Fax: (802) 864-4959

The provider's authorized official is Heather Lynn Diederich .
The authorized official title is Owner and has the following contact phone number (802) 434-6669.

The enumeration date for this NPI number is 7/29/2010 and was last updated on 9/21/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/Center006-0000998VERMONTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1VN1626MEDICAIDVERMONT
2VN1626MEDICARE UPINVERMONT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 7/9/2020

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