Provider Demographics
NPI:1497267561
Name:PURE MOTION PERFORMANCE AND THERAPY
Entity Type:Organization
Organization Name:PURE MOTION PERFORMANCE AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:EICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:480-489-5732
Mailing Address - Street 1:10133 N 92ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4556
Mailing Address - Country:US
Mailing Address - Phone:480-681-5119
Mailing Address - Fax:
Practice Address - Street 1:10133 N 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4556
Practice Address - Country:US
Practice Address - Phone:480-681-5119
Practice Address - Fax:480-681-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13320261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy