Healthcare Provider Details

I. General information

NPI: 1255174371
Provider Name (Legal Business Name): REHAB IN MOTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 COUNTY ROAD 210 W STE B
ST JOHNS FL
32259-2419
US

IV. Provider business mailing address

PO BOX 124
GALLMAN MS
39077-0124
US

V. Phone/Fax

Practice location:
  • Phone: 904-717-7782
  • Fax: 866-849-2728
Mailing address:
  • Phone: 866-808-4133
  • Fax: 866-849-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DARON WALTERS
Title or Position: OWNER
Credential:
Phone: 866-808-4133