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General NPI Number Information
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NPI Number | 1396278545
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Entity Type | Organization
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Legal Business Name | MOVEMENT FIRST
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 2290 SE BRISTOL ST
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0746
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Country | US
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Telephone | 949-261-6101
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Fax | 949-261-6126
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Provider Business Mailing Address
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Address Line | 2290 SE BRISTOL ST
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0746
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Country | US
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Telephone | 949-261-6101
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Fax | 949-261-6126
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | MR. BRANDON DEDERICH
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Credential | MPT, MS, ATC
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Telephone | 949-261-6101
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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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