Healthcare Provider Details

I. General information

NPI: 1114195294
Provider Name (Legal Business Name): IN MOTION PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 EDWARDS DRIVE SUITE 112
PLAINFIELD IN
46168-4498
US

IV. Provider business mailing address

P.O. BOX 6069 DEPT #207
INDIANAPOLIS IN
46206-6069
US

V. Phone/Fax

Practice location:
  • Phone: 317-838-0702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: VAN EVANOFF
Title or Position: PRESIDENT
Credential: MD
Phone: 317-837-1999