Provider Demographics
NPI:1538904800
Name:IMPACT PELVIC HEALTH
Entity type:Organization
Organization Name:IMPACT PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:MORAN
Authorized Official - Last Name:O'HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:617-733-9219
Mailing Address - Street 1:437 D ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1925
Mailing Address - Country:US
Mailing Address - Phone:617-733-9219
Mailing Address - Fax:
Practice Address - Street 1:437 D ST APT 4C
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1925
Practice Address - Country:US
Practice Address - Phone:617-733-9219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy