Provider Demographics
NPI:1124666052
Name:EL PASO PELVIC HEALTH PLLC
Entity type:Organization
Organization Name:EL PASO PELVIC HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:915-209-7124
Mailing Address - Street 1:11500 PELLICANO DR STE A-9
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11500 PELLICANO DR
Practice Address - Street 2:STE A-9
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6064
Practice Address - Country:US
Practice Address - Phone:915-209-7124
Practice Address - Fax:915-247-4474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty