Provider Demographics
NPI:1346463700
Name:PHYSICAL THERAPY IN MOTION PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY IN MOTION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMERLIN
Authorized Official - Middle Name:U
Authorized Official - Last Name:SODUSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:402-926-4088
Mailing Address - Street 1:10020 NICHOLAS ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2189
Mailing Address - Country:US
Mailing Address - Phone:402-926-4088
Mailing Address - Fax:402-926-4197
Practice Address - Street 1:10020 NICHOLAS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-2189
Practice Address - Country:US
Practice Address - Phone:402-926-4088
Practice Address - Fax:402-926-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE271634SOMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NE271632SOMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NE272550Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NE098851PHMedicare ID - Type UnspecifiedPROVIDER NUMBER