Healthcare Provider Details

I. General information

NPI: 1548673544
Provider Name (Legal Business Name): THE MOVEMENT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 BALTIMORE AVE SUITE 207
COLLEGE PARK MD
20740-3627
US

IV. Provider business mailing address

3712 PERRY ST
BRENTWOOD MD
20722-1713
US

V. Phone/Fax

Practice location:
  • Phone: 240-328-8415
  • Fax:
Mailing address:
  • Phone: 240-328-8415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUTTA BRETTSCHNEIDER
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS
Phone: 240-328-8415