Organization
PELVIC SOUL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHANIEL WILLIAM MARTIN (MEMBER)
(716) 352-4064
Entity
Organization
Contact information
Practice address
412 E MADISON ST STE 1215, TAMPA, FL 33602-4619
(716) 445-1921
Mailing address
15012 REDCLIFF DR, TAMPA, FL 33625-1957
(716) 352-4064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2024
Last updated
09/13/2024
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