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General NPI Number Information
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NPI Number | 1922622067
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Entity Type | Organization
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Legal Business Name | ENLIVEN MOVEMENT, LLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 1316 RUTLEDGE AVE STE 108
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City | CHARLESTON
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State | SC
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Zip | 29403-3050
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Country | US
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Telephone | 845-242-8732
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 RUTLEDGE AVE STE 108
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City | CHARLESTON
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State | SC
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Zip | 29403-3050
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Country | US
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Telephone | 845-242-8732
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KERRI ANN WAEGELEIN
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Credential | PT, DPT, OCS
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Telephone | 845-242-8732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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