Provider Demographics
NPI:1144949090
Name:PELVIC WELLNESS PHYSICAL THERAPY
Entity type:Organization
Organization Name:PELVIC WELLNESS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:308-631-2524
Mailing Address - Street 1:16313 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-7501
Mailing Address - Country:US
Mailing Address - Phone:308-631-2524
Mailing Address - Fax:
Practice Address - Street 1:16313 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-7501
Practice Address - Country:US
Practice Address - Phone:308-631-2524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy