Provider Demographics
NPI:1194468744
Name:MOVING MOUNTAINS REHABILITATION
Entity Type:Organization
Organization Name:MOVING MOUNTAINS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRUECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:920-471-2643
Mailing Address - Street 1:9750 N 96TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5294
Mailing Address - Country:US
Mailing Address - Phone:920-471-2643
Mailing Address - Fax:
Practice Address - Street 1:9750 N 96TH ST APT 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5294
Practice Address - Country:US
Practice Address - Phone:920-471-2643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty