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General NPI Number Information
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NPI Number | 1114467222
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Entity Type | Organization
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Legal Business Name | ENGAGE MOVEMENT PHYSIO AND PERFORMANCE LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 961 MATLEY LN #170
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City | RENO
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State | NV
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Zip | 89502-2188
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Country | US
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Telephone | 702-480-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 10522 EAGLE FALLS WAY
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City | RENO
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State | NV
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Zip | 89521-4153
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Country | US
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Telephone | 702-480-0568
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | RAYMOND GORMAN
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Credential | DPT
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Telephone | 702-480-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2977
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License Number State | NV
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