Provider Demographics
NPI:1699583013
Name:TK WELLNESS LLC
Entity type:Organization
Organization Name:TK WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGUYONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-610-7250
Mailing Address - Street 1:5485 BETHELVIEW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9736
Mailing Address - Country:US
Mailing Address - Phone:678-947-4642
Mailing Address - Fax:
Practice Address - Street 1:5485 BETHELVIEW RD STE 220
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9736
Practice Address - Country:US
Practice Address - Phone:678-947-4642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty