Provider Demographics
NPI:1215984901
Name:INNOVATIONS IN WELLNESS INC
Entity type:Organization
Organization Name:INNOVATIONS IN WELLNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GOLDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:215-947-1174
Mailing Address - Street 1:4459 W SWAMP RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-1015
Mailing Address - Country:US
Mailing Address - Phone:215-947-1174
Mailing Address - Fax:215-434-7255
Practice Address - Street 1:4459 W SWAMP RD
Practice Address - Street 2:SUITE 300
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1015
Practice Address - Country:US
Practice Address - Phone:215-947-1174
Practice Address - Fax:215-434-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008431L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2424630000OtherINDEPENDENCE BLUE CROSS
PAWE1758489OtherPA BLUE SHIELD
PA0857936OtherAETNA
PAG0194015Medicare ID - Type Unspecified