Provider Demographics
NPI:1295191831
Name:IN MOTION PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:IN MOTION PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-323-5400
Mailing Address - Street 1:5304 PANOLA INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4065
Mailing Address - Country:US
Mailing Address - Phone:770-323-5400
Mailing Address - Fax:
Practice Address - Street 1:5304 PANOLA INDUSTRIAL BLVD
Practice Address - Street 2:SUITE M
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4065
Practice Address - Country:US
Practice Address - Phone:770-323-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency