Healthcare Provider Details

I. General information

NPI: 1780169029
Provider Name (Legal Business Name): MOVEMENT 4 LIFE PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14585 MANCHESTER RD
MANCHESTER MO
63011-3963
US

IV. Provider business mailing address

14585 MANCHESTER RD
MANCHESTER MO
63011-3963
US

V. Phone/Fax

Practice location:
  • Phone: 314-941-3970
  • Fax: 314-931-1352
Mailing address:
  • Phone: 314-941-3970
  • Fax: 314-931-1352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID W CANDY
Title or Position: OWNER / DOCTOR OF PHYSICAL THERAPY
Credential: PT, DPT
Phone: 314-941-3970