Healthcare Provider Details

I. General information

NPI: 1992994362
Provider Name (Legal Business Name): MINDS IN MOTION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 SECURITY PKWY SIGS SPORTPLEX
NEW ALBANY IN
47150-9374
US

IV. Provider business mailing address

1467 E PAULA DR
SCOTTSBURG IN
47170-6651
US

V. Phone/Fax

Practice location:
  • Phone: 812-418-3989
  • Fax:
Mailing address:
  • Phone: 812-752-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDACE S MEYER
Title or Position: CEO
Credential:
Phone: 812-752-5101