Provider Demographics
NPI:1447639802
Name:ADVANCED MOVEMENT STUDIO, LLC
Entity type:Organization
Organization Name:ADVANCED MOVEMENT STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, CSCS, CES
Authorized Official - Phone:920-209-1662
Mailing Address - Street 1:101 W EDISON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1367
Mailing Address - Country:US
Mailing Address - Phone:920-209-1662
Mailing Address - Fax:
Practice Address - Street 1:101 W EDISON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1367
Practice Address - Country:US
Practice Address - Phone:920-209-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112510242251X0800X
WI114539225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty