Healthcare Provider Details

I. General information

NPI: 1609080647
Provider Name (Legal Business Name): MOTION FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6995N 750 W
ORLAND IN
46776
US

IV. Provider business mailing address

6995N 750 W
ORLAND IN
46776
US

V. Phone/Fax

Practice location:
  • Phone: 260-829-6363
  • Fax:
Mailing address:
  • Phone: 484-888-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number05005005A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CATHERINE ELIZABETH COVELL
Title or Position: OWNER
Credential: PT
Phone: 260-829-6363