Provider Demographics
NPI:1457659583
Name:UP & MOVIN' PEDIATRIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:UP & MOVIN' PEDIATRIC PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LOREI
Authorized Official - Last Name:SPICKELMIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:951-961-9152
Mailing Address - Street 1:17835 LUNA CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9523
Mailing Address - Country:US
Mailing Address - Phone:951-961-9152
Mailing Address - Fax:951-776-8028
Practice Address - Street 1:6180 BROCKTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2228
Practice Address - Country:US
Practice Address - Phone:951-961-9152
Practice Address - Fax:951-776-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPJ3678C252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487969051OtherNPPES
CA=========OtherEMPLOYEE IDENTIFICATION NUMBER