Provider Demographics
NPI:1093110751
Name:THERAPY IN MOTION , INC
Entity Type:Organization
Organization Name:THERAPY IN MOTION , INC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-754-5400
Mailing Address - Street 1:169 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6113
Mailing Address - Country:US
Mailing Address - Phone:760-224-7173
Mailing Address - Fax:760-451-1108
Practice Address - Street 1:169 TERRACE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6113
Practice Address - Country:US
Practice Address - Phone:760-224-7173
Practice Address - Fax:760-451-1108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPY IN MOTION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2949320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities