Provider Demographics
NPI:1598327256
Name:EMPOWERED PELVIC HEALTH LLC
Entity Type:Organization
Organization Name:EMPOWERED PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, PRPC
Authorized Official - Phone:201-315-3063
Mailing Address - Street 1:160 SUMMIT AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1763
Mailing Address - Country:US
Mailing Address - Phone:201-305-0130
Mailing Address - Fax:
Practice Address - Street 1:160 SUMMIT AVE STE 204
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1763
Practice Address - Country:US
Practice Address - Phone:201-305-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty