Provider Demographics
NPI:1144579731
Name:MOVE ON PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:MOVE ON PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:307-764-4115
Mailing Address - Street 1:1201 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2126
Mailing Address - Country:US
Mailing Address - Phone:307-764-4115
Mailing Address - Fax:307-764-4116
Practice Address - Street 1:1201 E. 7TH STREET
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435
Practice Address - Country:US
Practice Address - Phone:307-764-4115
Practice Address - Fax:307-764-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty