MEDICARE: ON THE MOVE PHYSICAL THERAPY AND 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	261QP2000X	Physical Therapy Clinic/Center	PT021679	PA

General Provider Information

NPI Number	:	1619308889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE MOVE PHYSICAL THERAPY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1793 NEWARK ROAD
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1793 NEWARK RD
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-1106
Country	:	US
Telephone Number	:	484-883-1911
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER, PHYSICAL THERAPIST
Name	:	CARRIE LEESE
Credential	:	DPT
Telephone Number	:	484-883-1911

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	02/27/2014

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