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General NPI Number Information
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NPI Number | 1114537438
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Entity Type | Organization
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Legal Business Name | CONNECT MOVEMENT CENTER LLC
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Dates
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Enumeration Date | 08/01/2020
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 540 FRONT STREET
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City | FAIRPLAY
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State | CO
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Zip | 80440
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Country | US
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Telephone | 630-881-7866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1945
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City | FAIRPLAY
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State | CO
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Zip | 80440-1945
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Country | US
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Telephone | 719-293-5198
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CONNIE CHEN BENTIVOLIO
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Credential |
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Telephone | 719-838-4083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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