Provider Demographics
NPI:1659145670
Name:IMPETUS MOVEMENT AND REHAB
Entity Type:Organization
Organization Name:IMPETUS MOVEMENT AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAK-OCBINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:509-339-5524
Mailing Address - Street 1:2112 28TH AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1394
Mailing Address - Country:US
Mailing Address - Phone:509-339-5524
Mailing Address - Fax:
Practice Address - Street 1:14205 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5614
Practice Address - Country:US
Practice Address - Phone:509-339-5524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy