Healthcare Provider Details

I. General information

NPI: 1154535508
Provider Name (Legal Business Name): MOVIN & GROOVIN CHILDREN'S THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 INTERLOCHEN DR NE
ATLANTA GA
30342-3701
US

IV. Provider business mailing address

17 INTERLOCHEN DR NE
ATLANTA GA
30342-3701
US

V. Phone/Fax

Practice location:
  • Phone: 404-918-1828
  • Fax: 404-459-8948
Mailing address:
  • Phone: 404-918-1828
  • Fax: 404-459-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE H. SQUILLARIO
Title or Position: CEO
Credential: PT
Phone: 404-918-1828