Provider Demographics
NPI: | 1972861417 |
---|---|
Name: | IN MOTION THERAPY, INC |
Entity type: | Organization |
Organization Name: | IN MOTION THERAPY, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTINE |
Authorized Official - Middle Name: | LYNN |
Authorized Official - Last Name: | MADISON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 218-727-1180 |
Mailing Address - Street 1: | 2701 W SUPERIOR ST |
Mailing Address - Street 2: | STE 112 |
Mailing Address - City: | DULUTH |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55806-1856 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 218-727-1180 |
Mailing Address - Fax: | 218-727-1461 |
Practice Address - Street 1: | 2701 W SUPERIOR ST |
Practice Address - Street 2: | STE 112 |
Practice Address - City: | DULUTH |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55806-1856 |
Practice Address - Country: | US |
Practice Address - Phone: | 218-727-1180 |
Practice Address - Fax: | 218-727-1461 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-05-02 |
Last Update Date: | 2012-05-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 261QP2000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |