Provider Demographics
NPI:1871348821
Name:INNOVATIVE ERGONOMICS AND WELLNESS
Entity type:Organization
Organization Name:INNOVATIVE ERGONOMICS AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KEOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, CEAS
Authorized Official - Phone:302-388-9835
Mailing Address - Street 1:215 FENWICK AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3615
Mailing Address - Country:US
Mailing Address - Phone:302-388-9835
Mailing Address - Fax:
Practice Address - Street 1:14 MILL PARK CT STE C
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2262
Practice Address - Country:US
Practice Address - Phone:302-388-9835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy