Provider Demographics
NPI:1962036053
Name:MOTION REBOOT LLC
Entity Type:Organization
Organization Name:MOTION REBOOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-289-2811
Mailing Address - Street 1:476 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-5335
Mailing Address - Country:US
Mailing Address - Phone:954-289-2811
Mailing Address - Fax:
Practice Address - Street 1:476 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-5335
Practice Address - Country:US
Practice Address - Phone:954-289-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-27
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch