Provider Demographics
NPI:1922414473
Name:ENERGY REHAB WELLNESS AND TRAINING
Entity type:Organization
Organization Name:ENERGY REHAB WELLNESS AND TRAINING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-238-3485
Mailing Address - Street 1:177 CHAMPION DR # 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3711
Mailing Address - Country:US
Mailing Address - Phone:814-238-3485
Mailing Address - Fax:814-692-2272
Practice Address - Street 1:177 CHAMPION DR # 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3711
Practice Address - Country:US
Practice Address - Phone:814-238-3485
Practice Address - Fax:814-692-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-05
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012059L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty