Provider Demographics
NPI:1932430881
Name:WELLNESS BY DESIGN P.T.
Entity type:Organization
Organization Name:WELLNESS BY DESIGN P.T.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHNA
Authorized Official - Middle Name:JATWANI
Authorized Official - Last Name:LALONDE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-631-9009
Mailing Address - Street 1:2216 NEWPORT BLVD.
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-631-9009
Mailing Address - Fax:949-631-1984
Practice Address - Street 1:2216 NEWPORT BLVD.
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-631-9009
Practice Address - Fax:949-631-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35135225100000X
CAPT36220225100000X
CAPT21767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT21767Medicare UPIN