Healthcare Provider Details

I. General information

NPI: 1194400176
Provider Name (Legal Business Name): MVMT PHYSICAL THERAPY AND PERFORMANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SPECIALTY DR STE E
VISTA CA
92081-8567
US

IV. Provider business mailing address

3972 BARRANCA PKWY STE J324
IRVINE CA
92606-1204
US

V. Phone/Fax

Practice location:
  • Phone: 949-490-0685
  • Fax: 949-593-0204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE SERRANO
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 562-253-7597