Provider Demographics
NPI:1497395263
Name:PIVOTAL MOVEMENT EXPERTS, PLLC
Entity Type:Organization
Organization Name:PIVOTAL MOVEMENT EXPERTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:509-531-5100
Mailing Address - Street 1:3019 DUPORTAIL ST # 170
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-6103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4033 WEST VAN GIESEN ST.
Practice Address - Street 2:UNIT #C
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353
Practice Address - Country:US
Practice Address - Phone:509-531-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy