Provider Demographics
NPI: | 1144579731 |
---|---|
Name: | MOVE ON PHYSICAL THERAPY, INC. |
Entity Type: | Organization |
Organization Name: | MOVE ON PHYSICAL THERAPY, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KENNETH |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | RODEMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 307-764-4115 |
Mailing Address - Street 1: | 1201 E 7TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | POWELL |
Mailing Address - State: | WY |
Mailing Address - Zip Code: | 82435-2126 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 307-764-4115 |
Mailing Address - Fax: | 307-764-4116 |
Practice Address - Street 1: | 1201 E. 7TH STREET |
Practice Address - Street 2: | |
Practice Address - City: | POWELL |
Practice Address - State: | WY |
Practice Address - Zip Code: | 82435 |
Practice Address - Country: | US |
Practice Address - Phone: | 307-764-4115 |
Practice Address - Fax: | 307-764-4116 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-08-29 |
Last Update Date: | 2012-11-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Single Specialty |