Basic Information
| Provider Information | |||||||||
| NPI: | 1801838404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH IN MOTION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 586 SHEPARD ST | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545013552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153655252 | ||||||||
| FaxNumber: | 7153655258 | ||||||||
| Practice Location | |||||||||
| Address1: | 586 SHEPARD ST | ||||||||
| Address2: | |||||||||
| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545013552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153655252 | ||||||||
| FaxNumber: | 7153655258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| AuthorizedOfficialLastName: | THORSEN | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 7153655252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3896-024 | WI | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40420000 | 05 | WI | MEDICAID |