Provider Demographics
NPI:1619754926
Name:MOVEWELL PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:MOVEWELL PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:MOVEWELL PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LODELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-331-0337
Mailing Address - Street 1:5522 FREELAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-9734
Mailing Address - Country:US
Mailing Address - Phone:360-331-0337
Mailing Address - Fax:360-331-4292
Practice Address - Street 1:5522 FREELAND AVE
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-9734
Practice Address - Country:US
Practice Address - Phone:425-327-8056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty