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General NPI Number Information
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NPI Number | 1679337380
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Entity Type | Organization
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Legal Business Name | THE MOVEMENT LAB
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 10 ALMEIDA AVE
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-1027
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Country | US
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Telephone | 401-578-3682
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Fax |
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Provider Business Mailing Address
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Address Line | 75 SUNSET DR
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1914
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Country | US
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Telephone | 401-578-3682
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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 | MARK P CASIMIRO
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Credential | DPT, ATC
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Telephone | 401-578-3682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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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