Wellness Tribe Physical Therapy Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

WELLNESS TRIBE PHYSICAL THERAPY INC

Practice address

2062 Business Center Dr Ste 140
Irvine, CA 92612-1109

Phone

(949) 264-9858

Fax

(949) 988-2969

NPI assigned

Jan 24, 2022

Organization subpart

No

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

Authorized official

Name

Alex Zhidetskiy, DPT

Title

Physical Therapist

Phone

(562) 761-9942

Specialties & licenses 1

Addresses

Other names 1

• Wellness Tribe Physical Therapy Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael J Russo, PT

  • Orthopedic Physical Therapist
  • Newport Beach, CA
  • NPI 1265737563
  Medicare reassignment Care Compare group NPD
• Aleksandr Zhidetskiy, DPT

  • Physical Therapist
  • Long Beach, CA
  • NPI 1215474440
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1215689880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2062 BUSINESS CENTER DR STE 140",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926121109",
            "telephone_number": "949-264-9858",
            "fax_number": "949-988-2969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2062 BUSINESS CENTER DR STE 140",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926121109",
            "telephone_number": "949-264-9858",
            "fax_number": "949-988-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS TRIBE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "ZHIDETSKIY",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "562-761-9942",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Tribe Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wellness Tribe Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Carla Suzanne Wells, M.D.
• Madison B Wells
• Wellvora LLC
• Ronald Reiner Wempen, MD
• Judy Weng

• Physical Therapist in Irvine, CA
• Providers in Irvine, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.