Provider Demographics
NPI:1255111324
Name:MOTION MEDIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:MOTION MEDIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT PAULO
Authorized Official - Middle Name:FORMALEJO
Authorized Official - Last Name:PANGANIBAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-887-2090
Mailing Address - Street 1:6420 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7111
Mailing Address - Country:US
Mailing Address - Phone:541-887-2090
Mailing Address - Fax:
Practice Address - Street 1:6420 S 6TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-7111
Practice Address - Country:US
Practice Address - Phone:541-887-2090
Practice Address - Fax:855-719-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty