Provider Demographics
NPI:1033792387
Name:THE MOVEMENT LAB LLC
Entity type:Organization
Organization Name:THE MOVEMENT LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-361-2266
Mailing Address - Street 1:8475 S EASTERN AVE STE 105A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2863
Mailing Address - Country:US
Mailing Address - Phone:725-209-2049
Mailing Address - Fax:725-209-2059
Practice Address - Street 1:8475 S EASTERN AVE STE 105A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2863
Practice Address - Country:US
Practice Address - Phone:725-209-2049
Practice Address - Fax:725-209-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty