Provider Demographics
NPI:1568096238
Name:PHYSIO MOVEMENT & PERFORMANCE, PLLC
Entity Type:Organization
Organization Name:PHYSIO MOVEMENT & PERFORMANCE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:SARA
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:253-200-0741
Mailing Address - Street 1:7719 64TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-5515
Mailing Address - Country:US
Mailing Address - Phone:253-200-0741
Mailing Address - Fax:
Practice Address - Street 1:615 S BAKER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-2318
Practice Address - Country:US
Practice Address - Phone:253-200-0741
Practice Address - Fax:253-300-1665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy