Provider Demographics
NPI:1063924025
Name:MOMS IN MOTION
Entity type:Organization
Organization Name:MOMS IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:THEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-573-5751
Mailing Address - Street 1:6937 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3919
Mailing Address - Country:US
Mailing Address - Phone:414-573-5751
Mailing Address - Fax:
Practice Address - Street 1:6937 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3919
Practice Address - Country:US
Practice Address - Phone:414-573-5751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management