Healthcare Provider Details

I. General information

NPI: 1699334441
Provider Name (Legal Business Name): MVMT PERFORMANCE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2866 GENTLE HILLS DR
DE PERE WI
54115-8157
US

IV. Provider business mailing address

2866 GENTLE HILLS DR
DE PERE WI
54115-8157
US

V. Phone/Fax

Practice location:
  • Phone: 414-418-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TREVOR FOLKER
Title or Position: MEMBER
Credential: MS, LAT, ATC
Phone: 414-418-5599