Proactive Rehab and Wellness, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PROACTIVE REHAB AND WELLNESS, LLC

Practice address

29161 Lake Ave
Paynesville, MN 56362-9385

Phone

(701) 318-2402

NPI assigned

Sep 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katie Rose Wendroth, PT

Title

Owner

Phone

(701) 318-2402

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631318400000",
    "number": "1013686138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29161 LAKE AVE",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563629385",
            "telephone_number": "701-318-2402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29161 LAKE AVE",
            "city": "PAYNESVILLE",
            "state": "MN",
            "postal_code": "563629385",
            "telephone_number": "701-318-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE REHAB AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-11",
        "last_updated": "2021-09-11",
        "certification_date": "2021-09-11",
        "status": "A",
        "authorized_official_last_name": "WENDROTH",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-318-2402",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Paynesville, MN
• Providers in Paynesville, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.