Provider Demographics
NPI:1811648793
Name:PURELY PELVIC FLOOR REHAB
Entity type:Organization
Organization Name:PURELY PELVIC FLOOR REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:817-233-8350
Mailing Address - Street 1:1402 N CORINTH ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208
Mailing Address - Country:US
Mailing Address - Phone:817-233-8350
Mailing Address - Fax:214-594-8266
Practice Address - Street 1:1402 N CORINTH ST
Practice Address - Street 2:SUITE 117
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208
Practice Address - Country:US
Practice Address - Phone:817-233-8350
Practice Address - Fax:214-594-8266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1121150OtherSTATE LICENSE