Healthcare Provider Details

I. General information

NPI: 1619308889
Provider Name (Legal Business Name): ON THE MOVE PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1793 NEWARK RD
KENNETT SQUARE PA
19348-1106
US

IV. Provider business mailing address

1793 NEWARK ROAD
KENNETT SQUARE PA
19348
US

V. Phone/Fax

Practice location:
  • Phone: 484-883-1911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT021679
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CARRIE LEESE
Title or Position: CO-OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 484-883-1911