Healthcare Provider Details

I. General information

NPI: 1932947371
Provider Name (Legal Business Name): MOVEMENT CLINIC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MOUNTAIN ST UNIT 12
PASADENA CA
91103-3070
US

IV. Provider business mailing address

1 W MOUNTAIN ST UNIT 12
PASADENA CA
91103-3070
US

V. Phone/Fax

Practice location:
  • Phone: 209-614-3560
  • Fax:
Mailing address:
  • Phone: 209-614-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JORDAN MCCORMACK
Title or Position: OWNER
Credential: PT, DPT, OCS
Phone: 626-669-3778