Provider Demographics
NPI:1548896442
Name:IMOVE TELEPT, LLC
Entity type:Organization
Organization Name:IMOVE TELEPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:636-578-3649
Mailing Address - Street 1:2018 LONG GATE CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7415
Mailing Address - Country:US
Mailing Address - Phone:636-578-3649
Mailing Address - Fax:
Practice Address - Street 1:2018 LONG GATE CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7415
Practice Address - Country:US
Practice Address - Phone:636-578-3649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty