Provider Demographics
NPI:1518601897
Name:EVOLVE PELVIC WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLVE PELVIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:715-349-3891
Mailing Address - Street 1:909 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2937
Mailing Address - Country:US
Mailing Address - Phone:715-348-3891
Mailing Address - Fax:
Practice Address - Street 1:909 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2937
Practice Address - Country:US
Practice Address - Phone:715-348-3891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty