Provider Demographics
NPI:1073208559
Name:AUTONOMY PELVIC HEALTH
Entity Type:Organization
Organization Name:AUTONOMY PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:978-855-9636
Mailing Address - Street 1:221 WEST ST APT 12
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-6336
Mailing Address - Country:US
Mailing Address - Phone:978-855-9636
Mailing Address - Fax:
Practice Address - Street 1:221 WEST ST APT 12
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-6336
Practice Address - Country:US
Practice Address - Phone:978-855-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center