NPIMap

Organization Active NPI

Energy Rehab Wellness and Training

  • Physical Therapist
  • State College, PA
National Provider Identifier
1922414473
Registry record updated Sep 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT012059L Issued in PA
Legal business name
ENERGY REHAB WELLNESS AND TRAINING
Practice address
177 Champion Dr # 100
State College, PA 16803-3711
Phone
(814) 238-3485
Fax
(814) 692-2272
NPI assigned
Jul 5, 2014
Last updated
Sep 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2025

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

Authorized official

Name
Nicole L Mellott
Title
Office Manager
Phone
(814) 238-3485

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT012059L PA Primary

Addresses

Primary practice location

177 Champion Dr # 100
State College, PA 16803-3711

Mailing address

177 Champion Dr # 100
State College, PA 16803-3711
Phone (814) 238-3485

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140915002394 PA Part B Supplier - Clinic/Group Practice 1153540620 Receives reassigned benefits from 19 practitioners
Practice locations: Port Matilda, PA; State College, PA

National Provider Directory

National Provider Directory

Locations

1300 Leonard St
Clearfield, PA 16830
Phone (814) 238-3485

177 Champion Dr
State College, PA 16803

177 Champion Dr
#100
State College, PA 16803
Phone (814) 238-3485

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1404518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1922414473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 CHAMPION DR # 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033711",
            "telephone_number": "814-238-3485",
            "fax_number": "814-692-2272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 CHAMPION DR # 100",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168033711",
            "telephone_number": "814-238-3485",
            "fax_number": "814-692-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENERGY REHAB WELLNESS AND TRAINING",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-05",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "MELLOTT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "814-238-3485"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT012059L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.