Provider Demographics
NPI:1487710786
Name:MOVE LEARN & GROW PC
Entity type:Organization
Organization Name:MOVE LEARN & GROW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUNEETHA
Authorized Official - Middle Name:RENU
Authorized Official - Last Name:RAMAWICKRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, GCFP
Authorized Official - Phone:248-462-4870
Mailing Address - Street 1:977 HILLSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-4287
Mailing Address - Country:US
Mailing Address - Phone:248-462-4870
Mailing Address - Fax:248-852-4937
Practice Address - Street 1:977 HILLSBOROUGH DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4287
Practice Address - Country:US
Practice Address - Phone:248-462-4870
Practice Address - Fax:248-852-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV52056Medicare UPIN
MI0P29150Medicare PIN