Healthcare Provider Details

I. General information

NPI: 1962036053
Provider Name (Legal Business Name): MOTION REBOOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 SE 14TH ST
DANIA BEACH FL
33004-5335
US

IV. Provider business mailing address

476 SE 14TH ST
DANIA BEACH FL
33004-5335
US

V. Phone/Fax

Practice location:
  • Phone: 954-289-2811
  • Fax:
Mailing address:
  • Phone: 954-289-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IAN SHARP
Title or Position: CEO
Credential: PHD
Phone: 954-289-2811