Provider Demographics
NPI:1972337319
Name:CENTER FOR PEDIATRIC MOVEMENT LLC
Entity type:Organization
Organization Name:CENTER FOR PEDIATRIC MOVEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:952-600-5882
Mailing Address - Street 1:6600 FRANCE AVE S STE 164
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1802
Mailing Address - Country:US
Mailing Address - Phone:952-600-5882
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 164
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1802
Practice Address - Country:US
Practice Address - Phone:952-600-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier