Healthcare Provider Details

I. General information

NPI: 1366030769
Provider Name (Legal Business Name): ADVANCED IN MOTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2021
Last Update Date: 01/02/2021
Certification Date: 01/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SPANISH OAK DR
BARDSTOWN KY
40004-3271
US

IV. Provider business mailing address

302 SPANISH OAK DR
BARDSTOWN KY
40004-3271
US

V. Phone/Fax

Practice location:
  • Phone: 502-510-0003
  • Fax:
Mailing address:
  • Phone: 502-510-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TAYLOR
Title or Position: OWNER/THERAPIST
Credential: OTR/L
Phone: 502-510-0003