Provider Demographics
NPI:1346657483
Name:FLUIDITY MOVEMENT AND WELLNESS
Entity Type:Organization
Organization Name:FLUIDITY MOVEMENT AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:614-300-7917
Mailing Address - Street 1:4530 ARENDELL PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8711
Mailing Address - Country:US
Mailing Address - Phone:614-300-7917
Mailing Address - Fax:
Practice Address - Street 1:2572 OAKSTONE DR STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7614
Practice Address - Country:US
Practice Address - Phone:614-300-7917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020950225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty