Provider Demographics
NPI:1780224196
Name:MOVING MOUNTAINS THERAPY AT HOME LLC
Entity Type:Organization
Organization Name:MOVING MOUNTAINS THERAPY AT HOME LLC
Other - Org Name:MOVING MOUNTAINS THERAPY AT HOME LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:DONIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS, ATC
Authorized Official - Phone:360-306-1383
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0783
Mailing Address - Country:US
Mailing Address - Phone:541-316-6520
Mailing Address - Fax:
Practice Address - Street 1:20469 JACKLIGHT LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3074
Practice Address - Country:US
Practice Address - Phone:360-306-1383
Practice Address - Fax:541-316-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty