Advanced Wellness Louisiana LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

07612 Issued in LA

Legal business name

ADVANCED WELLNESS LOUISIANA LLC

Practice address

9808 Bluebonnet Blvd Ste 201
Baton Rouge, LA 70810-6442

Phone

(225) 202-6124

NPI assigned

Aug 28, 2017

Last updated

Sep 8, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kristopher William Grunewald, DPT

Title

Owner/Physical Therapist

Phone

(225) 202-6124

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1504828800000",
    "number": "1861919060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 N WOODCHASE CT",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084023",
            "telephone_number": "225-202-6124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9808 BLUEBONNET BLVD STE 201",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708106442",
            "telephone_number": "225-202-6124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED WELLNESS LOUISIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-09-08",
        "status": "A",
        "authorized_official_last_name": "GRUNEWALD",
        "authorized_official_first_name": "KRISTOPHER",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "225-202-6124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "07612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Baton Rouge, LA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2017; 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.