| Rooting Wild Movement Llc | |
|
4130 Ridge Ave Ste 5600 Philadelphia PA 19129-1534 | |
| (985) 257-6774 | |
| Not Available |
| Full Name | Rooting Wild Movement Llc |
|---|---|
| Speciality | Counselor |
| Location | 4130 Ridge Ave Ste 5600, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Grace B Harman (OWNER/THERAPIST) |
| Authorized Official Contact | 9852576774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rooting Wild Movement Llc Po Box 5600 Philadelphia PA 19129-0600 Ph: () - | Rooting Wild Movement Llc 4130 Ridge Ave Ste 5600 Philadelphia PA 19129-1534 Ph: (985) 257-6774 |
| NPI Number | 1174351704 |
|---|---|
| Provider Enumeration Date | 07/24/2024 |
| Last Update Date | 07/24/2024 |
| Certification Date | 07/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174351704 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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