Healthcare Provider Details

I. General information

NPI: 1598275919
Provider Name (Legal Business Name): MOVE TO SUCCESS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 LIVERNOIS RD STE 165
TROY MI
48083-5061
US

IV. Provider business mailing address

1121 CHOPIN ST
TROY MI
48083-1815
US

V. Phone/Fax

Practice location:
  • Phone: 248-707-0136
  • Fax: 248-792-0510
Mailing address:
  • Phone: 248-881-5405
  • Fax: 248-792-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017913
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501017913
License Number StateMI

VIII. Authorized Official

Name: AMANDA KIRK
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT
Phone: 248-881-5405