Provider Demographics
NPI:1508621087
Name:THE MOVEMENT LAB
Entity Type:Organization
Organization Name:THE MOVEMENT LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:405-250-0233
Mailing Address - Street 1:1224 LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4932
Mailing Address - Country:US
Mailing Address - Phone:405-250-0233
Mailing Address - Fax:
Practice Address - Street 1:825 ROYAL WAY
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-593-8674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy