Healthcare Provider Details

I. General information

NPI: 1134731755
Provider Name (Legal Business Name): MOVEMENT 4 WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 E CHESTNUT AVE UNIT 2
MERCHANTVILLE NJ
08109-2505
US

IV. Provider business mailing address

331 PRESTON AVE APT 206
VOORHEES NJ
08043-1722
US

V. Phone/Fax

Practice location:
  • Phone: 856-434-7755
  • Fax:
Mailing address:
  • Phone: 787-669-1896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNESTO RAUL MENDEZ
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: PT, DPT, OCS
Phone: 787-669-1896