Organization
KTP WELLNESS SOLUTION LLC
Active
Other names
BIO-WORX WELNESS THERAPY LLC, KTP WELLNESS SOLUTION, BIO-WORX WELLNESS THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THELISA Y SULTON NP (OWNER)
(803) 404-7418
Entity
Organization
Contact information
Practice address
201 COLUMBIA MALL BLVD STE 189, COLUMBIA, SC 29223-7550
(803) 404-7418
(888) 958-0279
Mailing address
201 COLUMBIA MALL BLVD STE 189, COLUMBIA, SC 29223-7550
(803) 404-7418
(888) 958-0279
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345678
MULTI- SPECIALITY CLINIC
SC
Enumeration date
12/13/2019
Last updated
02/03/2020
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