Healthcare Provider Details

I. General information

NPI: 1821156076
Provider Name (Legal Business Name): PEDIATRIC PHYSICAL THERAPY KIDS ON THE MOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW 16TH AVE
GAINESVILLE FL
32601
US

IV. Provider business mailing address

KIDS ON THE MOVE 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 Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2703
License Number StateFL

VIII. Authorized Official

Name: DR. CLAUDIA SENESAC
Title or Position: PRES OWNER
Credential: PT, PHD, PCS
Phone: 352-373-7337