Provider Demographics
NPI:1457168908
Name:MOVEMENT SOLUTIONS MOBILE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:MOVEMENT SOLUTIONS MOBILE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:907-301-1856
Mailing Address - Street 1:1950 MATZEN RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-8595
Mailing Address - Country:US
Mailing Address - Phone:907-301-1856
Mailing Address - Fax:
Practice Address - Street 1:25 HILL DR
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1078
Practice Address - Country:US
Practice Address - Phone:907-301-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty