Healthcare Provider Details

I. General information

NPI: 1346655784
Provider Name (Legal Business Name): TOTAL MOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 NW GILSON RD
PALM CITY FL
34990-4907
US

IV. Provider business mailing address

13208 HARBOUR RIDGE BLVD
PALM CITY FL
34990-4809
US

V. Phone/Fax

Practice location:
  • Phone: 310-387-2805
  • Fax:
Mailing address:
  • Phone: 310-387-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number27026
License Number StateFL

VIII. Authorized Official

Name: ANDREA NELSON
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 310-387-2805