Provider Demographics
NPI:1932822004
Name:HEALTH IN MOTION REHAB SERVICES
Entity Type:Organization
Organization Name:HEALTH IN MOTION REHAB SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TACHICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-660-6081
Mailing Address - Street 1:3446 JERSEY LN
Mailing Address - Street 2:
Mailing Address - City:SUAMICO
Mailing Address - State:WI
Mailing Address - Zip Code:54313-3624
Mailing Address - Country:US
Mailing Address - Phone:920-660-6081
Mailing Address - Fax:
Practice Address - Street 1:2530 LINEVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-8861
Practice Address - Country:US
Practice Address - Phone:920-857-3126
Practice Address - Fax:920-273-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty