MEDICARE: THE MOVEMENT LAB LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1033792387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MOVEMENT LAB LLC

Provider Business Mailing Address
First Line	:	8475 S EASTERN AVE STE 105A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2863
Country	:	US
Telephone Number	:	725-209-2049
Fax Number	:	725-209-2059

Provider Business Practice Location Address
First Line	:	8475 S EASTERN AVE STE 105A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2863
Country	:	US
Telephone Number	:	725-209-2049
Fax Number	:	725-209-2059

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MELISSA YOUNG
Credential	:
Telephone Number	:	801-361-2266

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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Directions to “THE MOVEMENT LAB LLC ” Practice Location

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