Provider Demographics
NPI:1952133993
Name:REWIRED MOVEMENT PHYSICAL THERAPY AND PERFORMANCE PLLC
Entity type:Organization
Organization Name:REWIRED MOVEMENT PHYSICAL THERAPY AND PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:360-742-6217
Mailing Address - Street 1:2321 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2911
Mailing Address - Country:US
Mailing Address - Phone:360-742-6217
Mailing Address - Fax:
Practice Address - Street 1:2321 S 16TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2911
Practice Address - Country:US
Practice Address - Phone:360-742-6217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty