Provider Demographics
NPI:1811095318
Name:MADE TO MOVE PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MADE TO MOVE PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT, OCS, CHT
Authorized Official - Phone:310-535-0008
Mailing Address - Street 1:615 N NASH ST
Mailing Address - Street 2:STE # 306
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2825
Mailing Address - Country:US
Mailing Address - Phone:310-535-0008
Mailing Address - Fax:310-535-0009
Practice Address - Street 1:615 N NASH ST
Practice Address - Street 2:STE # 306
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2825
Practice Address - Country:US
Practice Address - Phone:310-535-0008
Practice Address - Fax:310-535-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0302660Medicaid
CA6415260001Medicare NSC
CAW20208Medicare PIN
CAWPT30266AMedicare PIN