Provider Demographics
NPI:1770849374
Name:MOVE IT THERAPY, LLC
Entity Type:Organization
Organization Name:MOVE IT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:810-766-9944
Mailing Address - Street 1:3499 S LINDEN RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3022
Mailing Address - Country:US
Mailing Address - Phone:810-766-9944
Mailing Address - Fax:
Practice Address - Street 1:3499 S LINDEN RD
Practice Address - Street 2:SUITE # 5
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3022
Practice Address - Country:US
Practice Address - Phone:810-766-9944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5677Medicare PIN