Provider Demographics
NPI:1982384400
Name:AWAKEN PELVIC THERAPY
Entity Type:Organization
Organization Name:AWAKEN PELVIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:810-656-9862
Mailing Address - Street 1:6906 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:SILVERWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48760-9402
Mailing Address - Country:US
Mailing Address - Phone:810-656-9862
Mailing Address - Fax:810-272-4402
Practice Address - Street 1:359 W NEPESSING ST STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2182
Practice Address - Country:US
Practice Address - Phone:810-656-9862
Practice Address - Fax:810-272-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy