Healthcare Provider Details

I. General information

NPI: 1942890793
Provider Name (Legal Business Name): 5 ELEMENTS PELVIC HEALTH AND WOMENS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 MAIN ST
MORRO BAY CA
93442-2750
US

IV. Provider business mailing address

184 MAIN ST
MORRO BAY CA
93442-2750
US

V. Phone/Fax

Practice location:
  • Phone: 808-382-2655
  • Fax:
Mailing address:
  • Phone: 808-382-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANN FROST
Title or Position: OWNER
Credential: PT
Phone: 808-382-2655