Provider Demographics
NPI:1225769086
Name:WELL WOMEN PELVIC HEALTH, LLC
Entity Type:Organization
Organization Name:WELL WOMEN PELVIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDORKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-939-6896
Mailing Address - Street 1:216 LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-0717
Mailing Address - Country:US
Mailing Address - Phone:207-939-6896
Mailing Address - Fax:
Practice Address - Street 1:216 LANCELOT LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-0717
Practice Address - Country:US
Practice Address - Phone:207-939-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy