Healthcare Provider Details

I. General information

NPI: 1679337380
Provider Name (Legal Business Name): THE MOVEMENT LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ALMEIDA AVE
EAST PROVIDENCE RI
02914-1027
US

IV. Provider business mailing address

75 SUNSET DR
EAST GREENWICH RI
02818-1914
US

V. Phone/Fax

Practice location:
  • Phone: 401-578-3682
  • Fax:
Mailing address:
  • Phone: 401-578-3682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK P CASIMIRO
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT, ATC
Phone: 401-578-3682