Provider Demographics
NPI:1053143966
Name:HOMEBODY PELVIC HEALTH LLC
Entity type:Organization
Organization Name:HOMEBODY PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:802-318-2502
Mailing Address - Street 1:6363 N CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4783
Mailing Address - Country:US
Mailing Address - Phone:802-318-2502
Mailing Address - Fax:
Practice Address - Street 1:6363 N CONCORD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-4783
Practice Address - Country:US
Practice Address - Phone:802-318-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty