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General NPI Number Information
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NPI Number | 1134060114
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Entity Type | Organization
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Legal Business Name | PURELY PELVIC THERAPY, PLLC
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 3134 WENDELL BLVD STE 2
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City | WENDELL
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State | NC
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Zip | 27591-7271
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Country | US
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Telephone | 919-804-8542
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Fax |
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Provider Business Mailing Address
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Address Line | 213 BROWNING MILL DR
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City | WENDELL
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State | NC
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Zip | 27591-6626
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Country | US
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Telephone | 860-944-0245
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | VICKI GOTHARD
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Credential | OTR/L
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Telephone | 860-944-0245
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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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