MEDICARE: HOLISTIC PELVIC HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1669070926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC PELVIC HEALTH

Provider Business Mailing Address
First Line	:	2506 TRAMWAY TERRACE CT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2317
Country	:	US
Telephone Number	:	505-280-6674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 COAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-5206
Country	:	US
Telephone Number	:	505-280-6674
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TALIA GILMOUR
Credential	:	DPT
Telephone Number	:	505-280-6674

Provider Enumeration Date	:	10/09/2020
Last Update Date	:	10/09/2020

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