Provider Demographics
NPI:1588342869
Name:MOVEMENT PERFORMANCE CENTER
Entity type:Organization
Organization Name:MOVEMENT PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CCTP,CCBHP
Authorized Official - Phone:571-215-3172
Mailing Address - Street 1:21816 CRESCENT PARK SQ STE 1816
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4418
Mailing Address - Country:US
Mailing Address - Phone:571-215-3172
Mailing Address - Fax:571-386-2534
Practice Address - Street 1:7439 LINTON HALL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-2977
Practice Address - Country:US
Practice Address - Phone:571-215-3172
Practice Address - Fax:571-386-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty