Healthcare Provider Details

I. General information

NPI: 1972194884
Provider Name (Legal Business Name): PURE MOVEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 WARNER AVE
SANTA FE NM
87505-5452
US

IV. Provider business mailing address

1935 WARNER AVE
SANTA FE NM
87505-5452
US

V. Phone/Fax

Practice location:
  • Phone: 505-906-6683
  • Fax:
Mailing address:
  • Phone: 505-906-6683
  • 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. MATTHEW SULLIVAN
Title or Position: OWNER
Credential: PT, DPT
Phone: 505-906-6683