Wholistic Revolution LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

WHOLISTIC REVOLUTION LLC

Practice address

4076 Biddle Ave
Wyandotte, MI 48192-7116

Phone

(734) 558-6532

NPI assigned

Mar 1, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth Walter Poucket

Title

Owner

Phone

(734) 558-6532

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1646092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1316693161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4076 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481927116",
            "telephone_number": "734-558-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4076 BIDDLE AVE",
            "city": "WYANDOTTE",
            "state": "MI",
            "postal_code": "481927116",
            "telephone_number": "734-558-6532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHOLISTIC REVOLUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-01",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "POUCKET",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-558-6532",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kenneth@thewholisticrevolution.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4076 Biddle Ave",
            "city": "Wyandotte",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481927116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kenneth Bartley Welsh, M.D.
• Cassie Ann Welt, D.O,
• Bernadette Mary White, DNP, MS, RN-BC, NEA-
• David Jason White, FNP
• Michael Wesley Whitworth, D.O.
• Jordyn Wiedyke, OTD, OTR/L
• Jill E Wiesenberger, D.O.
• Kathleen Ann Wilkins, RD
• Rachel Williams, DO
• Desaraea Wilson

• Physical Therapy Clinic/Center in Wyandotte, MI
• Providers in Wyandotte, MI by specialty
• Physical Therapy Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.