Provider Demographics
NPI:1639746993
Name:MICHIGAN IN MOTION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MICHIGAN IN MOTION PHYSICAL THERAPY, LLC
Other - Org Name:MICHIGAN IN MOTION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:586-991-1399
Mailing Address - Street 1:52900 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3573
Mailing Address - Country:US
Mailing Address - Phone:586-991-1399
Mailing Address - Fax:
Practice Address - Street 1:52900 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-3573
Practice Address - Country:US
Practice Address - Phone:586-991-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty