Healthcare Provider Details

I. General information

NPI: 1841132669
Provider Name (Legal Business Name): ACTIVE PELVIC HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CARLISLE BLVD NE STE D
ALBUQUERQUE NM
87107-4529
US

IV. Provider business mailing address

PO BOX 50201
ALBUQUERQUE NM
87181-0201
US

V. Phone/Fax

Practice location:
  • Phone: 505-490-1788
  • Fax:
Mailing address:
  • Phone: 505-490-1788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY ELIZABETH MENK
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 505-490-1788