Healthcare Provider Details

I. General information

NPI: 1992483010
Provider Name (Legal Business Name): MOTION WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SW 5TH TER # B
WILLISTON FL
32696-2548
US

IV. Provider business mailing address

510 SW 5TH TER # B
WILLISTON FL
32696-2548
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-5433
  • Fax:
Mailing address:
  • Phone: 352-528-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD J FONTAINE III
Title or Position: CEO/OWNER
Credential: DC
Phone: 401-641-3421