Provider Demographics
NPI:1043830961
Name:MOVEMENT SPACE PHYSICAL THERAPY
Entity type:Organization
Organization Name:MOVEMENT SPACE PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:615-655-3198
Mailing Address - Street 1:2316 GOSFORD RD APT X
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5399
Mailing Address - Country:US
Mailing Address - Phone:615-655-3198
Mailing Address - Fax:661-365-0152
Practice Address - Street 1:1811 OAK ST STE 150
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3064
Practice Address - Country:US
Practice Address - Phone:612-414-0896
Practice Address - Fax:661-365-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty