Healthcare Provider Details

I. General information

NPI: 1679760862
Provider Name (Legal Business Name): IN MOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4776 HODGES BLVD SUITE 101
JACKSONVILLE FL
32224-7217
US

IV. Provider business mailing address

4776 HODGES BLVD SUITE 101
JACKSONVILLE FL
32224-7217
US

V. Phone/Fax

Practice location:
  • Phone: 904-223-2363
  • Fax: 904-223-2365
Mailing address:
  • Phone: 904-223-2363
  • Fax: 904-223-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN K WIEST
Title or Position: OWNER
Credential:
Phone: 904-671-0255