MEDICARE: BORN TO MOVE PHYSICAL THERAPY & WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	2251P0200X	Pediatric Physical Therapist

General Provider Information

NPI Number	:	1306658059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORN TO MOVE PHYSICAL THERAPY & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	8300 BLUFF SPRINGS RD APT 231
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-6868
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8300 BLUFF SPRINGS RD APT 231
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78744-6868
Country	:	US
Telephone Number	:	806-928-1103
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	PRISCILLA FRYE-PATCH
Credential	:	PT, DPT
Telephone Number	:	512-766-9128

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	05/06/2025

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