Provider Demographics
NPI:1649389271
Name:ADVANCED INTEGRATIVE MOVEMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED INTEGRATIVE MOVEMENT, LLC
Other - Org Name:AIM PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-292-7245
Mailing Address - Street 1:PO BOX 11009
Mailing Address - Street 2:CASCADE BILLING
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98508-1009
Mailing Address - Country:US
Mailing Address - Phone:360-352-2037
Mailing Address - Fax:360-352-0637
Practice Address - Street 1:3000 LIMITED LN NW
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2704
Practice Address - Country:US
Practice Address - Phone:360-292-7245
Practice Address - Fax:360-292-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00004067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7131063Medicaid
WA0212356OtherL & I
WA7131063Medicaid