Healthcare Provider Details

I. General information

NPI: 1487354577
Provider Name (Legal Business Name): LOTUS PELVIC HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 08/02/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SIMSBURY RD STE C
AVON CT
06001-4235
US

IV. Provider business mailing address

120 SIMSBURY RD STE C
AVON CT
06001-4235
US

V. Phone/Fax

Practice location:
  • Phone: 860-965-8483
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. CAILYN RAE MCDONNELL
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 860-965-8483