Healthcare Provider Details

I. General information

NPI: 1083339147
Provider Name (Legal Business Name): MOTION MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW STE 306
LARGO FL
33770-3120
US

IV. Provider business mailing address

2050 5TH AVE
CONCORD CA
94518-1109
US

V. Phone/Fax

Practice location:
  • Phone: 855-920-2377
  • Fax:
Mailing address:
  • Phone: 619-253-3267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KEIKO SARGENT
Title or Position: HEAD OF CLINICAL OPERATIONS
Credential:
Phone: 855-920-2377