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General NPI Number Information
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NPI Number | 1598275919
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Entity Type | Organization
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Legal Business Name | MOVE TO SUCCESS PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 3150 LIVERNOIS RD STE 165
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City | TROY
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State | MI
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Zip | 48083-5061
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Country | US
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Telephone | 248-707-0136
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Fax | 248-792-0510
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Provider Business Mailing Address
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Address Line | 1121 CHOPIN ST
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City | TROY
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State | MI
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Zip | 48083-1815
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Country | US
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Telephone | 248-881-5405
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Fax | 248-792-0510
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | AMANDA KIRK
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Credential | DPT
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Telephone | 248-881-5405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 5501017913
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017913
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License Number State | MI
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