Healthcare Provider Details

I. General information

NPI: 1669070926
Provider Name (Legal Business Name): HOLISTIC PELVIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 COAL AVE SE
ALBUQUERQUE NM
87106-5206
US

IV. Provider business mailing address

2506 TRAMWAY TERRACE CT NE
ALBUQUERQUE NM
87122-2317
US

V. Phone/Fax

Practice location:
  • Phone: 505-280-6674
  • Fax:
Mailing address:
  • Phone: 505-280-6674
  • 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: TALIA GILMOUR
Title or Position: OWNER
Credential: DPT
Phone: 505-280-6674