Provider Demographics
NPI:1114607132
Name:ENOVO LLC
Entity Type:Organization
Organization Name:ENOVO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONG LINH
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:316-796-2497
Mailing Address - Street 1:113 M AND M LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-2562
Mailing Address - Country:US
Mailing Address - Phone:316-796-2497
Mailing Address - Fax:
Practice Address - Street 1:113 M AND M LN UNIT C
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2562
Practice Address - Country:US
Practice Address - Phone:316-796-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty