Healthcare Provider Details

I. General information

NPI: 1588997928
Provider Name (Legal Business Name): HEALTH IN MOTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21615 N HACKAMORE LN
PAULDEN AZ
86334-4613
US

IV. Provider business mailing address

21615 N HACKAMORE LN
PAULDEN AZ
86334-4613
US

V. Phone/Fax

Practice location:
  • Phone: 928-925-4388
  • Fax: 928-636-9894
Mailing address:
  • Phone: 928-925-4388
  • Fax: 928-636-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1743
License Number StateAZ

VIII. Authorized Official

Name: MS. CHERYL BARR VAN DEMARK
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 928-925-4388