Whole Self Wellness, Llc | |
627 Norwich Salem Tpke Unit 2 Oakdale CT 06370-1066 | |
(860) 222-0949 | |
(888) 326-5828 |
Full Name | Whole Self Wellness, Llc |
---|---|
Speciality | Clinic/Center |
Location | 627 Norwich Salem Tpke Unit 2, Oakdale, Connecticut |
Authorized Official Name and Position | Andrea Stephanie Dameron (APRN/OWNER) |
Authorized Official Contact | 8602220949 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Whole Self Wellness, Llc 627 Norwich Salem Tpke Unit 2 Oakdale CT 06370-1066 Ph: (860) 222-0949 | Whole Self Wellness, Llc 627 Norwich Salem Tpke Unit 2 Oakdale CT 06370-1066 Ph: (860) 222-0949 |
NPI Number | 1588114870 |
---|---|
Provider Enumeration Date | 10/11/2016 |
Last Update Date | 12/02/2020 |
Medicare PECOS PAC ID | 1850673559 |
---|---|
Medicare Enrollment ID | O20170112001502 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588114870 | NPI | - | NPPES |
1356624027 | Other | CT | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | 004768 (Connecticut) | Primary |
Provider Name | Beth A Tannatt |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1811960750 PECOS PAC ID: 3072539808 Enrollment ID: I20100728000004 |
Provider Name | Andrea S Dameron |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1356624027 PECOS PAC ID: 4981879640 Enrollment ID: I20111207000413 |
Provider Name | Lorie A Deshong |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1154509354 PECOS PAC ID: 2668799271 Enrollment ID: I20150319000797 |
Provider Name | Christina Barr |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1861173825 PECOS PAC ID: 6002270097 Enrollment ID: I20230908002295 |