Provider Demographics
NPI:1811148935
Name:ON THE MOVE PEDIATRIC THERAPY
Entity type:Organization
Organization Name:ON THE MOVE PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-401-2941
Mailing Address - Street 1:1001 MONARCH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1848
Mailing Address - Country:US
Mailing Address - Phone:859-401-2941
Mailing Address - Fax:480-323-2104
Practice Address - Street 1:1001 MONARCH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1848
Practice Address - Country:US
Practice Address - Phone:859-401-2941
Practice Address - Fax:480-323-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0049302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty