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General NPI Number Information
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NPI Number | 1982372470
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Entity Type | Organization
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Legal Business Name | PELVIC GRACE PT AND WELLNESS
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 233 SUNDAY CIR
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-9558
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Country | US
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Telephone | 602-757-4631
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2671
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-1924
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Country | US
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Telephone | 602-757-4631
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MISS KATHRYN HOLLAND
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Credential | DPT
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Telephone | 602-757-4631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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