Healthcare Provider Details

I. General information

NPI: 1912549189
Provider Name (Legal Business Name): THE MVMT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 PAOLI PIKE STE 1
FLOYDS KNOBS IN
47119-9787
US

IV. Provider business mailing address

3620 PAOLI PIKE STE 1
FLOYDS KNOBS IN
47119-9787
US

V. Phone/Fax

Practice location:
  • Phone: 812-903-0001
  • Fax: 812-903-0097
Mailing address:
  • Phone: 812-903-0001
  • Fax: 812-903-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN P LANNAN
Title or Position: OWNER
Credential: PT, DPT, OCS
Phone: 812-903-0001