Basic Information
| Provider Information | |||||||||
| NPI: | 1538422324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IN MOTION PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 370 E SOUTH TEMPLE | ||||||||
| Address2: | 250 | ||||||||
| City: | SLC | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841111324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017559186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 669 WYNGATE POINTE LN | ||||||||
| Address2: | |||||||||
| City: | DRAPER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840209695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017559186 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 08/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | BLAKE | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8017559186 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 7272273-0160 | UT | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.