Provider Demographics
NPI:1326233719
Name:MOVEMENT DYNAMICS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:MOVEMENT DYNAMICS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-343-1357
Mailing Address - Street 1:7147 CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5642
Mailing Address - Country:US
Mailing Address - Phone:303-343-1357
Mailing Address - Fax:303-343-3036
Practice Address - Street 1:651 POTOMAC ST
Practice Address - Street 2:SUITE B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6731
Practice Address - Country:US
Practice Address - Phone:303-343-1357
Practice Address - Fax:303-343-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty