Provider Demographics
NPI:1184394371
Name:MOVE SPORT SPINE
Entity type:Organization
Organization Name:MOVE SPORT SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-238-6683
Mailing Address - Street 1:4133 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6409
Mailing Address - Country:US
Mailing Address - Phone:318-238-6683
Mailing Address - Fax:833-733-6683
Practice Address - Street 1:4133 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6409
Practice Address - Country:US
Practice Address - Phone:318-238-6683
Practice Address - Fax:833-733-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty