Provider Demographics
NPI:1427503317
Name:ADVANCED WELLNESS SYSTEMS, LLC
Entity type:Organization
Organization Name:ADVANCED WELLNESS SYSTEMS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-361-2225
Mailing Address - Street 1:46 W GUDE DR STE 46B
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1150
Mailing Address - Country:US
Mailing Address - Phone:240-361-2225
Mailing Address - Fax:240-361-0719
Practice Address - Street 1:46 W GUDE DR STE 46B
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1150
Practice Address - Country:US
Practice Address - Phone:240-361-2225
Practice Address - Fax:240-361-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD700056100Medicaid
MD325517Medicare PIN