Provider Demographics
NPI:1902686892
Name:EVANSVILLE PELVIC WELLNESS & REHABILITATION LLC
Entity Type:Organization
Organization Name:EVANSVILLE PELVIC WELLNESS & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-777-4080
Mailing Address - Street 1:4600 WASHINGTON AVE STE 106B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0888
Mailing Address - Country:US
Mailing Address - Phone:812-777-4080
Mailing Address - Fax:
Practice Address - Street 1:4600 WASHINGTON AVE STE 106B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0888
Practice Address - Country:US
Practice Address - Phone:812-777-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty