Healthcare Provider Details

I. General information

NPI: 1952246217
Provider Name (Legal Business Name): GRACE PELVIC HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SPLIT ROCK LN
PARK RIDGE NJ
07656-1040
US

IV. Provider business mailing address

123 SPLIT ROCK LN
PARK RIDGE NJ
07656-1040
US

V. Phone/Fax

Practice location:
  • Phone: 631-942-6752
  • Fax: 631-942-6752
Mailing address:
  • Phone: 631-942-6752
  • Fax: 631-942-6752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELISSA MARIE MORGAN
Title or Position: PELVIC HEALTH PRACTITIONER
Credential: OTR/L ,CFPHP, TIPHP
Phone: 631-942-6752