Provider Demographics
NPI:1881208726
Name:IMOTION WELLNESS AND FITNESS
Entity Type:Organization
Organization Name:IMOTION WELLNESS AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:510-431-2190
Mailing Address - Street 1:555 MOWRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4101
Mailing Address - Country:US
Mailing Address - Phone:510-431-2190
Mailing Address - Fax:510-939-8040
Practice Address - Street 1:555 MOWRY AVE STE A
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4101
Practice Address - Country:US
Practice Address - Phone:510-431-2190
Practice Address - Fax:510-939-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty