Provider Demographics
NPI:1508698549
Name:PELVICARE PHYSICAL THERAPY
Entity type:Organization
Organization Name:PELVICARE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GULYAMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-459-5298
Mailing Address - Street 1:1450 JUDSON DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6933
Mailing Address - Country:US
Mailing Address - Phone:617-459-5298
Mailing Address - Fax:
Practice Address - Street 1:7960 NIWOT RD UNIT C11
Practice Address - Street 2:
Practice Address - City:NIWOT
Practice Address - State:CO
Practice Address - Zip Code:80503-7150
Practice Address - Country:US
Practice Address - Phone:617-459-5298
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?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy