Healthcare Provider Details

I. General information

NPI: 1902144793
Provider Name (Legal Business Name): MOVEMENT SPORTS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 PEACHTREE RD NE STE 160 AT FUSION ATL
ATLANTA GA
30305-2430
US

IV. Provider business mailing address

3280 PEACHTREE RD NE STE 160 AT FUSION ATL
ATLANTA GA
30305-2430
US

V. Phone/Fax

Practice location:
  • Phone: 404-382-8667
  • Fax: 678-823-8214
Mailing address:
  • Phone: 404-382-8667
  • Fax: 678-823-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008407
License Number StateGA

VIII. Authorized Official

Name: BRIAN ARTHUR YEE
Title or Position: OWNER
Credential: PT
Phone: 404-441-0206