Provider Demographics
NPI:1063047728
Name:WELLNESS ELEVATED
Entity type:Organization
Organization Name:WELLNESS ELEVATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLECK
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:970-901-6771
Mailing Address - Street 1:WELLNESS ELEVATED 1 WESTERN WAY
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81231-0001
Mailing Address - Country:US
Mailing Address - Phone:970-901-6771
Mailing Address - Fax:
Practice Address - Street 1:HAP LAB PAUL WRIGHT GYM
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81231-0001
Practice Address - Country:US
Practice Address - Phone:970-943-3095
Practice Address - Fax:970-943-7125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN COLORADO UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Single Specialty