Provider Demographics
NPI:1013766047
Name:MOVEMENT RX
Entity type:Organization
Organization Name:MOVEMENT RX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:336-287-3284
Mailing Address - Street 1:75-233 NANI KAILUA DR APT 120
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-2073
Mailing Address - Country:US
Mailing Address - Phone:336-287-3284
Mailing Address - Fax:
Practice Address - Street 1:75-233 NANI KAILUA DR APT 120
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2073
Practice Address - Country:US
Practice Address - Phone:336-287-3284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI001948Medicaid