Provider Demographics
NPI:1396762886
Name:TRINITY WELLNESS CENTER, INC
Entity type:Organization
Organization Name:TRINITY WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUFFUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:919-875-1932
Mailing Address - Street 1:200 HORIZON DR STE 115
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4947
Mailing Address - Country:US
Mailing Address - Phone:919-875-1932
Mailing Address - Fax:919-875-1933
Practice Address - Street 1:200 HORIZON DR STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4947
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherPROVIDER TAX ID