Healthcare Provider Details

I. General information

NPI: 1740184761
Provider Name (Legal Business Name): GROUNDED FUNCTION & MOVEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 LEGACY LANE
VIENNA WV
26105
US

IV. Provider business mailing address

264 LEGACY LANE
VIENNA WV
26105
US

V. Phone/Fax

Practice location:
  • Phone: 304-615-4232
  • Fax:
Mailing address:
  • Phone: 304-615-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KYLIE WILLIAMS
Title or Position: OWNER/PT
Credential: DPT
Phone: 304-615-4232