Provider Demographics
NPI:1396405890
Name:MOVEMENT REDEFINED LLC
Entity Type:Organization
Organization Name:MOVEMENT REDEFINED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRANTES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:602-592-0940
Mailing Address - Street 1:4324 E BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4087
Mailing Address - Country:US
Mailing Address - Phone:602-592-0940
Mailing Address - Fax:
Practice Address - Street 1:10050 N SCOTTSDALE RD STE 111
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-1498
Practice Address - Country:US
Practice Address - Phone:602-592-0940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty