| Organization Name: | ACTION THERAPY & WELLNESS CENTER, LLC |
| NPI Number: | 1083961577 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIDGET PETRIE (OWNER) |
| Mailing Address: | 211 E Worthy Road Bldg Iv Gonzales |
| State: | LA US |
| Postal Code: | 70737 |
| Phone Number: | 2556447044 |
| Fax Number: | 2256444414 |
| NPI Enumeration Date: | 08/14/2012 |
| NPI Last Update Date: | 04/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 04755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |