Provider Demographics
NPI: | 1477149185 |
---|---|
Name: | FOUNDATIONS PELVIC HEALTH, LLC |
Entity Type: | Organization |
Organization Name: | FOUNDATIONS PELVIC HEALTH, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PHYSICAL THERAPIST, OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DONNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHIAO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT, DPT |
Authorized Official - Phone: | 949-683-1942 |
Mailing Address - Street 1: | 62 CHANDLER ST # 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02116-6218 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 949-683-1942 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 304 COLUMBUS AVE GF |
Practice Address - Street 2: | |
Practice Address - City: | BOSTON |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02116-1295 |
Practice Address - Country: | US |
Practice Address - Phone: | 949-683-1942 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-12-16 |
Last Update Date: | 2022-03-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |