=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164023438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOVEO PERFORMANCE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2020
-----------------------------------------------------
Last Update Date | 05/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6624 N 10TH ST STE R
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-6463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-515-2055
-----------------------------------------------------
Fax | 956-515-2058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6624 N 10TH ST STE R
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-6463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-515-2055
-----------------------------------------------------
Fax | 956-515-2058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JOSE I SUAREZ
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 956-647-7842
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------