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General NPI Number Information
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NPI Number | 1073490231
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Entity Type | Organization
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Legal Business Name | MEDUSA PELVIC HEALTH AND WELLBEING LLC
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 120 ALISO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2693
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Country | US
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Telephone | 512-539-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 120 ALISO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-2693
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Country | US
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Telephone | 512-539-9390
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Fax |
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | NADINE LOUGHREY
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Credential | OTR/L
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Telephone | 512-569-9390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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