Provider Demographics
NPI:1477554442
Name:THE MOVEMENT SCIENCE CENTER
Entity Type:Organization
Organization Name:THE MOVEMENT SCIENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURGEOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-834-9259
Mailing Address - Street 1:321 VETERANS MEMORIAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3060
Mailing Address - Country:US
Mailing Address - Phone:504-834-9259
Mailing Address - Fax:504-834-9281
Practice Address - Street 1:321 VETERANS MEMORIAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3060
Practice Address - Country:US
Practice Address - Phone:504-834-9259
Practice Address - Fax:504-834-9281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
LA050292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460192Medicaid
LA5CJ13Medicare ID - Type UnspecifiedPROVIDER NUMBER
LA1460192Medicaid