Provider Demographics
NPI:1679760862
Name:IN MOTION PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:IN MOTION PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-671-0255
Mailing Address - Street 1:4776 HODGES BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7217
Mailing Address - Country:US
Mailing Address - Phone:904-223-2363
Mailing Address - Fax:904-223-2365
Practice Address - Street 1:4776 HODGES BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-7217
Practice Address - Country:US
Practice Address - Phone:904-223-2363
Practice Address - Fax:904-223-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy