Provider Demographics
NPI:1417307117
Name:MOVEMENT BEYOND PHYSICAL THERAPY SOLUTIONS, PC
Entity Type:Organization
Organization Name:MOVEMENT BEYOND PHYSICAL THERAPY SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-456-8858
Mailing Address - Street 1:4604 JOHN HANCOCK CT
Mailing Address - Street 2:APT 201
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4919
Mailing Address - Country:US
Mailing Address - Phone:516-456-8858
Mailing Address - Fax:
Practice Address - Street 1:4215 EVERGREEN LN
Practice Address - Street 2:SUITE 201
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3210
Practice Address - Country:US
Practice Address - Phone:703-649-4271
Practice Address - Fax:877-628-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207264261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy