Healthcare Provider Details

I. General information

NPI: 1396064101
Provider Name (Legal Business Name): LIFE IN MOTION FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 BOWEN RD SE UNIT 10
WASHINGTON DC
20020-6654
US

IV. Provider business mailing address

2633 BOWEN RD SE UNIT 10
WASHINGTON DC
20020-6654
US

V. Phone/Fax

Practice location:
  • Phone: 202-629-8653
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ZENA WILLIAMS
Title or Position: CEO
Credential:
Phone: 202-629-8653