Provider Demographics
NPI:1386074854
Name:CORE MOVEMENT AND PERFORMANCE LLC
Entity type:Organization
Organization Name:CORE MOVEMENT AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:585-506-2277
Mailing Address - Street 1:407 D ST UNIT 404
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1944
Mailing Address - Country:US
Mailing Address - Phone:585-506-2277
Mailing Address - Fax:
Practice Address - Street 1:282 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5232
Practice Address - Country:US
Practice Address - Phone:585-506-2277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20631261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA003478401OtherPROVIDER MEDICARE NUMBER
MA003478401OtherPROVIDER MEDICARE NUMBER