Provider Demographics
NPI:1104060136
Name:SMART MOVES PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SMART MOVES PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:937-684-4660
Mailing Address - Street 1:2360 W DOROTHY LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1858
Mailing Address - Country:US
Mailing Address - Phone:937-684-4660
Mailing Address - Fax:937-684-4428
Practice Address - Street 1:2360 W DOROTHY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1858
Practice Address - Country:US
Practice Address - Phone:937-684-4660
Practice Address - Fax:937-684-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6163261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1659512689OtherNPPES INDIVIDUAL