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General NPI Number Information
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NPI Number | 1649817206
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Entity Type | Organization
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Legal Business Name | MOVE MOBILE THERAPY LLC
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 78 SUNBURST CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0147
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Country | US
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Telephone | 405-815-9494
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Fax |
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Provider Business Mailing Address
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Address Line | 78 SUNBURST CT
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0147
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Country | US
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Telephone | 405-815-9494
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. BRANDI RENFRO
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Credential | DPT
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Telephone | 405-815-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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