NPIMap

Organization Active NPI

My Wellness Team LLC

Doing business as 360 Wellness LLC

  • Physical Therapist
  • Cincinnati, OH
National Provider Identifier
1619651767
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MY WELLNESS TEAM LLC
Doing business as
360 Wellness LLC
Practice address
4916 N Bend Rd
Cincinnati, OH 45211-2360
Phone
(317) 750-1890
NPI assigned
Jun 9, 2023
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Mrs. Anne Robertson
Title
Business Administrator
Phone
(812) 267-2841

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

4916 N Bend Rd
Cincinnati, OH 45211-2360

Mailing address

911 E 86TH St
Suite 103
Indianapolis, IN 46240
Phone (812) 267-2841

Other names 1

  • 360 Wellness LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20231108003170 OH Part B Supplier - Clinic/Group Practice 5890142145 Receives reassigned benefits from 15 practitioners
Practice locations: Beavercreek, OH; Cincinnati, OH; Lebanon, OH; Loveland, OH; Madeira, OH
O20240410000479 IN Part B Supplier - Clinic/Group Practice 5890142145 Receives reassigned benefits from 26 practitioners
Practice locations: Sellersburg, IN; McCordsville, IN; Indianapolis, IN; Fishers, IN; Columbus, IN; Fort Wayne, IN; Avon, IN; Bloomington, IN

National Provider Directory

National Provider Directory

Locations

911 E 86th St
Ste 103
Indianapolis, IN 46240
Phone (812) 267-2841

6311 W 900 N
#360
McCordsville, IN 46055

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1619651767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E 86TH ST",
            "address_2": "SUITE 103",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46240",
            "telephone_number": "812-267-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4916 N BEND RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452112360",
            "telephone_number": "317-750-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY WELLNESS TEAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "ANNE",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "812-267-2841",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "360 Wellness LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "360 Wellness LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.