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General NPI Number Information
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NPI Number | 1447639802
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Entity Type | Organization
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Legal Business Name | ADVANCED MOVEMENT STUDIO, LLC
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Dates
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Enumeration Date | 05/19/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 101 W EDISON AVE SUITE 110
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City | APPLETON
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State | WI
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Zip | 54915-1367
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Country | US
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Telephone | 920-209-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W EDISON AVE SUITE 110
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City | APPLETON
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State | WI
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Zip | 54915-1367
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Country | US
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Telephone | 920-209-1662
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MR. ANDREW M BRAUN
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Credential | LAT, CSCS, CES
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Telephone | 920-209-1662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 114539
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 11251024
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License Number State | WI
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