Healthcare Provider Details

I. General information

NPI: 1710139639
Provider Name (Legal Business Name): PAULAS MOVEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 OCEAN DR
ST AUGUSTINE FL
32080-2915
US

IV. Provider business mailing address

409 OCEAN DR
ST AUGUSTINE FL
32080-2915
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-2591
  • Fax: 410-372-4039
Mailing address:
  • Phone: 904-460-2591
  • Fax: 410-372-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULA M MASTBOOM-BELL
Title or Position: OWNER/PRESIDENT
Credential: PT
Phone: 904-460-2389