Provider Demographics
NPI:1073490231
Name:MEDUSA PELVIC HEALTH AND WELLBEING LLC
Entity type:Organization
Organization Name:MEDUSA PELVIC HEALTH AND WELLBEING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUGHREY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:512-569-9390
Mailing Address - Street 1:120 ALISO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2693
Mailing Address - Country:US
Mailing Address - Phone:512-539-9390
Mailing Address - Fax:
Practice Address - Street 1:120 ALISO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2693
Practice Address - Country:US
Practice Address - Phone:512-539-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty