Provider Demographics
NPI:1083365225
Name:VITAL PELVIC HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:VITAL PELVIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GENOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR/L
Authorized Official - Phone:330-718-3482
Mailing Address - Street 1:820 KAUFMAN RD
Mailing Address - Street 2:
Mailing Address - City:ENON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:16120-3316
Mailing Address - Country:US
Mailing Address - Phone:330-718-3482
Mailing Address - Fax:
Practice Address - Street 1:58 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1978
Practice Address - Country:US
Practice Address - Phone:330-259-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty