Healthcare Provider Details

I. General information

NPI: 1487288916
Provider Name (Legal Business Name): IMOTION PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 W 10 MILE RD STE C
SOUTHFIELD MI
48033-4856
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 1645
BINGHAM FARMS MI
48025-4525
US

V. Phone/Fax

Practice location:
  • Phone: 586-822-0007
  • Fax:
Mailing address:
  • Phone: 248-283-1100
  • Fax: 248-283-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAUSHIK PATEL
Title or Position: CREDENTIALING
Credential:
Phone: 586-822-0007