Healthcare Provider Details

I. General information

NPI: 1659468684
Provider Name (Legal Business Name): KIDS ON THE MOVE - ROBIN ANDERSEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW 16TH AVE
GAINESVILLE FL
32601
US

IV. Provider business mailing address

1203 NW 16TH AVE
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7337
  • Fax: 352-377-3622
Mailing address:
  • Phone: 352-373-7337
  • Fax: 352-377-3622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1703
License Number StateFL

VIII. Authorized Official

Name: MRS. ROBIN P ANDERSEN
Title or Position: OWNER PT
Credential: PT
Phone: 352-373-7337