Provider Demographics
NPI:1609949171
Name:HEALING IN MOTION PLLC
Entity Type:Organization
Organization Name:HEALING IN MOTION PLLC
Other - Org Name:HEALING IN MOTION PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL, CHT
Authorized Official - Phone:734-913-4816
Mailing Address - Street 1:24520 MEADOWBROOK RD STE 225
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2867
Mailing Address - Country:US
Mailing Address - Phone:734-913-4816
Mailing Address - Fax:734-913-8021
Practice Address - Street 1:24520 MEADOWBROOK RD STE 225
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2867
Practice Address - Country:US
Practice Address - Phone:734-913-4816
Practice Address - Fax:734-913-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011880225100000X
MI5501005696225100000X
MI5201006188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP20200005OtherPTAN
MI0P20200OtherPTAN
MI0P20200OtherPTAN