Provider Demographics
NPI:1760905806
Name:WHOLISTIC MOTUS LLC
Entity Type:Organization
Organization Name:WHOLISTIC MOTUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:PAITRA
Authorized Official - Last Name:MOHLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:239-400-5639
Mailing Address - Street 1:2059 ALTAMONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3281
Mailing Address - Country:US
Mailing Address - Phone:239-400-5639
Mailing Address - Fax:866-835-2456
Practice Address - Street 1:2059 ALTAMONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3281
Practice Address - Country:US
Practice Address - Phone:239-400-5639
Practice Address - Fax:866-835-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29036261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy