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General NPI Number Information
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NPI Number | 1346818911
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Entity Type | Organization
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Legal Business Name | PELVIC PRIME, LLC
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 410 UNIVERSITY PKWY STE 2200
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City | AIKEN
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State | SC
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Zip | 29801-6833
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Country | US
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Telephone | 803-716-9723
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Fax | 803-845-4793
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Provider Business Mailing Address
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Address Line | 1002 EASTWOOD CT
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City | AIKEN
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State | SC
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Zip | 29801-8106
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Country | US
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Telephone | 803-716-9723
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Fax | 803-845-4793
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHANDREA JEAN HUBBS
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Credential | PT, DPT
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Telephone | 803-649-9797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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