Healthcare Provider Details

I. General information

NPI: 1558093310
Provider Name (Legal Business Name): MOVEMENT & PERFORMANCE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15201 BURNET RD BLDG D
AUSTIN TX
78728-3505
US

IV. Provider business mailing address

10301 BURNET RD APT 1228
AUSTIN TX
78758-4585
US

V. Phone/Fax

Practice location:
  • Phone: 512-525-2733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. GABRIEL DUNHAM
Title or Position: OWNER
Credential: DR.
Phone: 512-525-2733