Provider Demographics
NPI:1942982293
Name:PELVIS RESTORED, LLC
Entity Type:Organization
Organization Name:PELVIS RESTORED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:512-766-2786
Mailing Address - Street 1:4361 S CONGRESS AVE UNIT 111
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1289
Mailing Address - Country:US
Mailing Address - Phone:512-766-2786
Mailing Address - Fax:
Practice Address - Street 1:4361 S CONGRESS AVE UNIT 111
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1289
Practice Address - Country:US
Practice Address - Phone:512-766-2786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy