# OMNI WELLNESS GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Omni Wellness Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861982423
- **Authorized official:** SHEILA PETREQUIN (BILLING MANAGER)
- **Authorized official phone:** (937) 438-9500

## Contact information

- **Practice address:** 1149 EXPERIMENT FARM ROAD, TROY, OH 45373
- **Practice address phone:** (937) 540-9920
- **Practice address fax:** (937) 202-0213
- **Mailing address:** 1149 EXPERIMENT FARM RD, TROY, OH 45373-1071
- **Mailing address phone:** (937) 438-9500
- **Mailing address fax:** (937) 886-5694

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/18/2018
- **Last updated:** 10/30/2023