Healthcare Provider Details

I. General information

NPI: 1972861417
Provider Name (Legal Business Name): IN MOTION THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W SUPERIOR ST STE 112
DULUTH MN
55806-1856
US

IV. Provider business mailing address

2701 W SUPERIOR ST STE 112
DULUTH MN
55806-1856
US

V. Phone/Fax

Practice location:
  • Phone: 218-727-1180
  • Fax: 218-727-1461
Mailing address:
  • Phone: 218-727-1180
  • Fax: 218-727-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRISTINE LYNN MADISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 218-727-1180