Provider Demographics
NPI:1043064959
Name:EVERGREEN PELVIC HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:EVERGREEN PELVIC HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-870-6611
Mailing Address - Street 1:3439 SE HAWTHORNE BLVD # 1025
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:503-270-3086
Mailing Address - Fax:971-351-6651
Practice Address - Street 1:1001 SE WATER AVE STE 247
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2148
Practice Address - Country:US
Practice Address - Phone:503-270-3086
Practice Address - Fax:971-351-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No251E00000XAgenciesHome Health