Provider Demographics
NPI:1528848009
Name:MOVE2PERFORM LLC
Entity type:Organization
Organization Name:MOVE2PERFORM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:570-259-7087
Mailing Address - Street 1:1915 ENGLEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4321
Mailing Address - Country:US
Mailing Address - Phone:570-259-7087
Mailing Address - Fax:
Practice Address - Street 1:175 WELLES ST REAR
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4933
Practice Address - Country:US
Practice Address - Phone:570-310-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy