MEDICARE: HEALTH IN MOTION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	1743	AZ

General Provider Information

NPI Number	:	1588997928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH IN MOTION LLC

Provider Business Mailing Address
First Line	:	21615 N HACKAMORE LN
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-4613
Country	:	US
Telephone Number	:	928-925-4388
Fax Number	:	928-636-9894

Provider Business Practice Location Address
First Line	:	21615 N HACKAMORE LN
Second Line	:
City	:	PAULDEN
State	:	AZ
Zip	:	86334-4613
Country	:	US
Telephone Number	:	928-925-4388
Fax Number	:	928-636-9894

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. CHERYL BARR VAN DEMARK
Credential	:	PT
Telephone Number	:	928-925-4388

Provider Enumeration Date	:	09/17/2009
Last Update Date	:	11/23/2009

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Directions to “HEALTH IN MOTION LLC ” Practice Location

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