# GREENHOUSE WELLNESS AND PHYSICAL THERAPY, INC.

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

## Provider details

- **NPI number:** 1740946516
- **Authorized official:** KRISTIN PUPA JACONO DPT (PRESIDENT/PHYSICAL THERAPIST)
- **Authorized official phone:** (908) 581-6642

## Contact information

- **Practice address:** 647B BLAKE RD, ELKTON, MD 21921-1805
- **Practice address phone:** (443) 877-9934
- **Mailing address:** 370 WALNUT LN, NORTH EAST, MD 21901-6118
- **Mailing address phone:** (908) 581-6642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/16/2021
- **Last updated:** 12/15/2021