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General NPI Number Information
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NPI Number | 1073812806
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Entity Type | Organization
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Legal Business Name | MOVEMENT POTENTIAL PLLC
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 1900 ARBORO PL
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City | LOUISVILLE
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State | KY
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Zip | 40220-3576
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Country | US
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Telephone | 502-298-4932
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 ARBORO PL
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City | LOUISVILLE
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State | KY
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Zip | 40220-3576
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Country | US
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Telephone | 502-298-4932
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. JACK PAUL JACOBS
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Credential | PT, DPT
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Telephone | 502-298-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 005251
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License Number State | KY
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