Provider Demographics
NPI:1568236065
Name:MOVEWELL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOVEWELL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LIBERAOTRE
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:410-353-6085
Mailing Address - Street 1:1204 STEUBEN CT
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-3857
Mailing Address - Country:US
Mailing Address - Phone:410-353-6085
Mailing Address - Fax:
Practice Address - Street 1:1204 STEUBEN CT
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-3857
Practice Address - Country:US
Practice Address - Phone:410-353-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy