Basic Information
| Provider Information | |||||||||
| NPI: | 1316410517 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOINT VENTURES WELLNESS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 791 | ||||||||
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| City: | CARNEGIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151060791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126554362 | ||||||||
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| Practice Location | |||||||||
| Address1: | 491 E BRUCETON RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PLEASANT HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124274488 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2019 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | BILLINGS | ||||||||
| AuthorizedOfficialFirstName: | KRISTYN | ||||||||
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| AuthorizedOfficialTitleorPosition: | INSURANCE | ||||||||
| AuthorizedOfficialTelephone: | 4126554362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 111NR0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | DC007898L | 01 | PA | STATE LICENSE | OTHER |