MEDICARE: MOVEMENT SPORTS PHYSICAL THERAPY, 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	PT008407	GA

General Provider Information

NPI Number	:	1902144793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEMENT SPORTS PHYSICAL THERAPY, LLC

Provider Business Mailing Address
First Line	:	3280 PEACHTREE RD NE STE 160
Second Line	:	AT FUSION ATL
City	:	ATLANTA
State	:	GA
Zip	:	30305-2430
Country	:	US
Telephone Number	:	404-382-8667
Fax Number	:	678-823-8214

Provider Business Practice Location Address
First Line	:	3280 PEACHTREE RD NE STE 160
Second Line	:	AT FUSION ATL
City	:	ATLANTA
State	:	GA
Zip	:	30305-2430
Country	:	US
Telephone Number	:	404-382-8667
Fax Number	:	678-823-8214

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN ARTHUR YEE
Credential	:	PT
Telephone Number	:	404-441-0206

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	08/27/2013

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