# WILD PHYSICAL THERAPY AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174360176
- **Authorized official:** MOLLYE LEAS-MEDREK DPT (OWNER)
- **Authorized official phone:** (812) 662-5033

## Contact information

- **Practice address:** 545 PAWTUCKET AVE \# LL04A, PAWTUCKET, RI 02860-6046
- **Practice address phone:** (812) 662-5033
- **Mailing address:** 555 N MAIN ST \# 1439, PROVIDENCE, RI 02904-5722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 07/09/2024
- **Last updated:** 07/09/2024