Provider Demographics
NPI:1619704509
Name:UPLIFT PELVIC HEALTH LLC
Entity type:Organization
Organization Name:UPLIFT PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:918-720-1757
Mailing Address - Street 1:1517 MESA TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2841
Mailing Address - Country:US
Mailing Address - Phone:918-720-1757
Mailing Address - Fax:
Practice Address - Street 1:610 S KELLY AVE STE D
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-5697
Practice Address - Country:US
Practice Address - Phone:405-256-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty