Thewell

Primary specialty

Clinical Exercise PhysiologistTaxonomy code 224Y00000X

Legal business name

THEWELL

Practice address

28150 Tavistock TRL
Southfield, MI 48034-5180

Phone

(313) 283-8620

NPI assigned

Sep 10, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Camilla Nicole Nelson, M.ED

Title

President/Foundress

Phone

(313) 283-8620

Specialties & licenses 1

Addresses

Other names 1

• Uplift Athletics Former legal business name

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536537600000",
    "number": "1114400785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28150 TAVISTOCK TRL",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345180",
            "telephone_number": "313-283-8620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28150 TAVISTOCK TRL",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480345180",
            "telephone_number": "313-283-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEWELL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2018-09-10",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CAMILLA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT/FOUNDRESS",
        "authorized_official_telephone_number": "313-283-8620",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.ED"
    },
    "taxonomies": [
        {
            "code": "224Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Exercise Physiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Uplift Athletics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Uplift Athletics",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Uplift Athletics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Elliott Ryan Thieme, AUD.
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• Thomas M Flake Jr MD PC
• Thomas Mays MD , PC

• Clinical Exercise Physiologist in Southfield, MI
• Providers in Southfield, MI by specialty
• Clinical Exercise Physiologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2018; 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.