Provider Demographics
NPI:1578370144
Name:ALPHA WELLNESS LLC
Entity type:Organization
Organization Name:ALPHA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:STAFFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:262-200-1205
Mailing Address - Street 1:W274N7316 HOWARDS PASS
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53089-1867
Mailing Address - Country:US
Mailing Address - Phone:262-200-1205
Mailing Address - Fax:
Practice Address - Street 1:N64W24050 MAIN ST STE 306B
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-3000
Practice Address - Country:US
Practice Address - Phone:262-200-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty