Provider Demographics
NPI:1710139639
Name:PAULAS MOVEMENT CENTER INC
Entity Type:Organization
Organization Name:PAULAS MOVEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASTBOOM-BELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:904-460-2389
Mailing Address - Street 1:409 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-2915
Mailing Address - Country:US
Mailing Address - Phone:904-460-2591
Mailing Address - Fax:410-372-4039
Practice Address - Street 1:409 OCEAN DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-2915
Practice Address - Country:US
Practice Address - Phone:904-460-2591
Practice Address - Fax:410-372-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty