Provider Demographics
NPI:1538532148
Name:MOVEMENT SCIENCE PHYSICAL THERAPY AND FITNESS INC
Entity type:Organization
Organization Name:MOVEMENT SCIENCE PHYSICAL THERAPY AND FITNESS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:626-365-1380
Mailing Address - Street 1:145 VISTA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:145 VISTA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3607
Practice Address - Country:US
Practice Address - Phone:626-365-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 36996225100000X
CADC 32302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty