Healthcare Provider Details

I. General information

NPI: 1326630955
Provider Name (Legal Business Name): MOTIV PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 W 1ST ST APT 3A
DULUTH MN
55802-1683
US

IV. Provider business mailing address

414 W 1ST ST APT 3A
DULUTH MN
55802-1683
US

V. Phone/Fax

Practice location:
  • Phone: 763-242-6217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEX LOCH
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 763-242-6217