Provider Demographics
NPI:1770213225
Name:BOUNDLESS MOVEMENT LLC
Entity Type:Organization
Organization Name:BOUNDLESS MOVEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:913-213-3632
Mailing Address - Street 1:13908 S BROOKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1928
Mailing Address - Country:US
Mailing Address - Phone:217-414-5321
Mailing Address - Fax:
Practice Address - Street 1:13908 S BROOKWOOD CT
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1928
Practice Address - Country:US
Practice Address - Phone:217-414-5321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy