Healthcare Provider Details

I. General information

NPI: 1326856782
Provider Name (Legal Business Name): PRIMROSE PELVIC THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 UPLAND TER
BALA CYNWYD PA
19004-3126
US

IV. Provider business mailing address

117 UPLAND TER
BALA CYNWYD PA
19004-3126
US

V. Phone/Fax

Practice location:
  • Phone: 215-776-7677
  • Fax:
Mailing address:
  • Phone: 215-776-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIMONE DINOVITZ
Title or Position: CEO/PHYSICAL THERAPIST
Credential:
Phone: 215-776-7677