Provider Demographics
NPI:1104026459
Name:MOVEMENT ARTS PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MOVEMENT ARTS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:805-497-0388
Mailing Address - Street 1:46 LORI LN
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1231
Mailing Address - Country:US
Mailing Address - Phone:805-484-9353
Mailing Address - Fax:
Practice Address - Street 1:2239 TOWNSGATE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2405
Practice Address - Country:US
Practice Address - Phone:805-497-0388
Practice Address - Fax:805-497-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22425B261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy