Healthcare Provider Details

I. General information

NPI: 1629841408
Provider Name (Legal Business Name): IN MOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W TWINCOURT TRL UNIT 610
ST AUGUSTINE FL
32095-8805
US

IV. Provider business mailing address

559 W TWINCOURT TRL UNIT 610
ST AUGUSTINE FL
32095-8805
US

V. Phone/Fax

Practice location:
  • Phone: 904-671-0255
  • Fax: 904-671-0256
Mailing address:
  • Phone: 904-671-0255
  • Fax: 904-671-0256

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