Healthcare Provider Details

I. General information

NPI: 1619868080
Provider Name (Legal Business Name): LIFE IN MOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 CENTRAL AVE
DUBUQUE IA
52001-4853
US

IV. Provider business mailing address

2067 CLIFFORD ST
DUBUQUE IA
52002-0448
US

V. Phone/Fax

Practice location:
  • Phone: 563-204-8343
  • Fax:
Mailing address:
  • Phone: 563-543-3400
  • Fax:

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

VIII. Authorized Official

Name: LOGAN LYNCH
Title or Position: OWNER
Credential: PT
Phone: 563-543-3400