Healthcare Provider Details

I. General information

NPI: 1619327921
Provider Name (Legal Business Name): MOTUS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 FOREST LAWN DR SUITE 104
LOS ANGELES CA
90068-1046
US

IV. Provider business mailing address

3315 BELLAIRE DR
ALTADENA CA
91001-4411
US

V. Phone/Fax

Practice location:
  • Phone: 323-851-7876
  • Fax:
Mailing address:
  • Phone: 323-304-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT24389
License Number StateCA

VIII. Authorized Official

Name: DARLENE EUBANKS
Title or Position: PRESIDENT
Credential: PT
Phone: 323-304-5950