MEDICARE: MOVE WELL AGE WELL, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1881215085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVE WELL AGE WELL, LLC

Provider Business Mailing Address
First Line	:	2693 E TEAL WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-2823
Country	:	US
Telephone Number	:	989-284-8969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 S HIGHLAND DR STE E6-256
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3672
Country	:	US
Telephone Number	:	801-839-5592
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	ALYSSA KUHN
Credential	:	DPT
Telephone Number	:	989-284-8969

Provider Enumeration Date	:	04/29/2020
Last Update Date	:	02/05/2021

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