Healthcare Provider Details

I. General information

NPI: 1205286549
Provider Name (Legal Business Name): MOVED BY MUSIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41664 REDS RD
PAONIA CO
81428-8310
US

IV. Provider business mailing address

41664 REDS RD
PAONIA CO
81428-8310
US

V. Phone/Fax

Practice location:
  • Phone: 719-431-3549
  • Fax:
Mailing address:
  • Phone: 970-527-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SUE JACKSON
Title or Position: OWNER
Credential: MM, MTBC
Phone: 719-431-3549