Healthcare Provider Details

I. General information

NPI: 1255860433
Provider Name (Legal Business Name): LIFE IN MOTION PHYSICAL & HAND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 OAKHURST RD STE A
SEMINOLE FL
33776-2156
US

IV. Provider business mailing address

9125 US HIGHWAY 19 N
PINELLAS PARK FL
33782-5406
US

V. Phone/Fax

Practice location:
  • Phone: 727-369-6355
  • Fax: 727-362-4766
Mailing address:
  • Phone: 727-369-6355
  • Fax: 727-362-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE D RIVEROS
Title or Position: CO-OWNER
Credential: MOTR/L
Phone: 727-369-6355