Provider Demographics
NPI:1417786542
Name:WELLNESS OF WARRIORS LLC
Entity type:Organization
Organization Name:WELLNESS OF WARRIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-718-6778
Mailing Address - Street 1:105 CAPITAL ST UNIT 206
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5223
Mailing Address - Country:US
Mailing Address - Phone:757-718-6778
Mailing Address - Fax:
Practice Address - Street 1:105 CAPITAL ST UNIT 206
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5223
Practice Address - Country:US
Practice Address - Phone:757-718-6778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty