Provider Demographics
NPI:1972136562
Name:FLOURISH PELVIC PT, LACTATION AND WELLNESS LLC
Entity type:Organization
Organization Name:FLOURISH PELVIC PT, LACTATION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, IBCLC
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DENDTLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, IBCLC
Authorized Official - Phone:678-767-2889
Mailing Address - Street 1:320 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3163
Mailing Address - Country:US
Mailing Address - Phone:678-767-2889
Mailing Address - Fax:
Practice Address - Street 1:320 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3163
Practice Address - Country:US
Practice Address - Phone:678-767-2889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty