Provider Demographics
NPI:1013527381
Name:MOVEMENT IS MEDICINE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Entity type:Organization
Organization Name:MOVEMENT IS MEDICINE PHYSICAL THERAPY AND SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-620-5464
Mailing Address - Street 1:4210 COLLEY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2508
Mailing Address - Country:US
Mailing Address - Phone:757-620-5464
Mailing Address - Fax:757-799-1668
Practice Address - Street 1:4210 COLLEY AVE STE A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2508
Practice Address - Country:US
Practice Address - Phone:757-620-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy