Provider Demographics
NPI: | 1033792387 |
---|---|
Name: | THE MOVEMENT LAB LLC |
Entity Type: | Organization |
Organization Name: | THE MOVEMENT LAB LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MELISSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | YOUNG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 801-361-2266 |
Mailing Address - Street 1: | 8475 S EASTERN AVE STE 105A |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89123-2863 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 725-209-2049 |
Mailing Address - Fax: | 725-209-2059 |
Practice Address - Street 1: | 8475 S EASTERN AVE STE 105A |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89123-2863 |
Practice Address - Country: | US |
Practice Address - Phone: | 725-209-2049 |
Practice Address - Fax: | 725-209-2059 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-04 |
Last Update Date: | 2021-05-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |