Provider Demographics
NPI:1386895050
Name:PRO-MOTION PHYSICAL THERAPY OF VOLUSIA CTY
Entity type:Organization
Organization Name:PRO-MOTION PHYSICAL THERAPY OF VOLUSIA CTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIE CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:386-492-2986
Mailing Address - Street 1:PO BOX 290699
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-0699
Mailing Address - Country:US
Mailing Address - Phone:386-492-2986
Mailing Address - Fax:386-492-2987
Practice Address - Street 1:4606 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 1-D
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6404
Practice Address - Country:US
Practice Address - Phone:386-492-2986
Practice Address - Fax:386-492-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6405000001Medicare NSC