Provider Demographics
NPI:1861051450
Name:MOVE ATHLETICS, LLC
Entity type:Organization
Organization Name:MOVE ATHLETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. ONGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:413-203-9359
Mailing Address - Street 1:573 PLUMTREE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1634
Mailing Address - Country:US
Mailing Address - Phone:413-505-6098
Mailing Address - Fax:
Practice Address - Street 1:45 TENNIS RD
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2353
Practice Address - Country:US
Practice Address - Phone:413-203-9359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy