Healthcare Provider Details

I. General information

NPI: 1306725320
Provider Name (Legal Business Name): EOS PELVIC HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 GYPSIE LN
EAST BEND NC
27018-8815
US

IV. Provider business mailing address

3723 GYPSIE LN
EAST BEND NC
27018-8815
US

V. Phone/Fax

Practice location:
  • Phone: 732-275-2344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATRINA JOHNSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-275-2344