MEDICARE: EMPOWERED PELVIC HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1598327256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERED PELVIC HEALTH LLC

Provider Business Mailing Address
First Line	:	160 SUMMIT AVE STE 204
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-305-0130
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SUMMIT AVE STE 204
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-305-0130
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLY GOSSARD
Credential	:	PT, DPT, OCS, PRPC
Telephone Number	:	201-315-3063

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	01/24/2023

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