Basic Information
| Provider Information | |||||||||
| NPI: | 1972861417 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IN MOTION THERAPY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 W SUPERIOR ST | ||||||||
| Address2: | STE 112 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558061856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187271180 | ||||||||
| FaxNumber: | 2187271461 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 W SUPERIOR ST | ||||||||
| Address2: | STE 112 | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558061856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187271180 | ||||||||
| FaxNumber: | 2187271461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2012 | ||||||||
| LastUpdateDate: | 05/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MADISON | ||||||||
| AuthorizedOfficialFirstName: | KRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2187271180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.