Provider Demographics
NPI:1447990171
Name:TRANSFORM PHYSICAL THERAPY AND WELLNESS LLC
Entity type:Organization
Organization Name:TRANSFORM PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCADA-SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:517-256-0548
Mailing Address - Street 1:3946 BLUE SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9259
Mailing Address - Country:US
Mailing Address - Phone:517-256-0548
Mailing Address - Fax:989-794-6084
Practice Address - Street 1:3946 BLUE SPRUCE DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9259
Practice Address - Country:US
Practice Address - Phone:517-256-0548
Practice Address - Fax:989-794-6084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty