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General NPI Number Information
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NPI Number | 1407667793
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Entity Type | Organization
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Legal Business Name | BOLD MOVE INTEGRATIVE WELLNESS
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 200 Q ST NE APT 2505
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City | WASHINGTON
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State | DC
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Zip | 20002-2397
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Country | US
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Telephone | 203-731-7224
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Fax |
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Provider Business Mailing Address
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Address Line | 200 Q ST NE APT 2505
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City | WASHINGTON
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State | DC
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Zip | 20002-2397
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Country | US
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Telephone |
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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 | DR. CYRUS BROWN
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Credential | DPT
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Telephone | 203-731-7224
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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 |
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License Number State |
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