Healthcare Provider Details

I. General information

NPI: 1225940133
Provider Name (Legal Business Name): FUNCTIONAL MOVEMENT THERAPEUTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SOUTHWIND DR
NORWALK CT
06854-1114
US

IV. Provider business mailing address

12 SOUTHWIND DR
NORWALK CT
06854-1114
US

V. Phone/Fax

Practice location:
  • Phone: 240-614-6494
  • Fax:
Mailing address:
  • Phone: 240-614-6494
  • 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: DAVE QUIRANTE
Title or Position: OWNER
Credential:
Phone: 240-614-6494