Provider Demographics
NPI:1285218750
Name:ON THE MOVE PODIATRY LLC
Entity Type:Organization
Organization Name:ON THE MOVE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRULLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-993-2700
Mailing Address - Street 1:19636 N 27TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4016
Mailing Address - Country:US
Mailing Address - Phone:602-993-2700
Mailing Address - Fax:602-993-2705
Practice Address - Street 1:19636 N 27TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4015
Practice Address - Country:US
Practice Address - Phone:602-993-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Multi-Specialty