Provider Demographics
NPI:1346818911
Name:PELVIC PRIME, LLC
Entity Type:Organization
Organization Name:PELVIC PRIME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANDREA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:803-649-9797
Mailing Address - Street 1:1002 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-8106
Mailing Address - Country:US
Mailing Address - Phone:803-716-9723
Mailing Address - Fax:803-845-4793
Practice Address - Street 1:410 UNIVERSITY PKWY STE 2200
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6833
Practice Address - Country:US
Practice Address - Phone:803-716-9723
Practice Address - Fax:803-845-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty