Provider Demographics
NPI:1295964625
Name:GRACEFUL MOVEMENT CENTER FOR FELDENKRAIS AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:GRACEFUL MOVEMENT CENTER FOR FELDENKRAIS AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRACE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:928-282-2520
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86339-0334
Mailing Address - Country:US
Mailing Address - Phone:928-282-2520
Mailing Address - Fax:928-282-2895
Practice Address - Street 1:3393 IRIS AVE
Practice Address - Street 2:STE 106
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5205
Practice Address - Country:US
Practice Address - Phone:928-282-2520
Practice Address - Fax:928-282-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty