Provider Demographics
NPI:1811337850
Name:KIDS IN MOTION THERAPY CLINIC
Entity type:Organization
Organization Name:KIDS IN MOTION THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:360-303-8966
Mailing Address - Street 1:4152 MERIDIAN ST STE 105
Mailing Address - Street 2:PMB 17
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-5589
Mailing Address - Country:US
Mailing Address - Phone:360-303-8966
Mailing Address - Fax:
Practice Address - Street 1:7551 W 22ND AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9780
Practice Address - Country:US
Practice Address - Phone:360-303-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-307-514261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty