Healthcare Provider Details

I. General information

NPI: 1578614863
Provider Name (Legal Business Name): MOTION PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 OHIO ST
RACINE WI
53405-3123
US

IV. Provider business mailing address

PO BOX 367
ROCHESTER WI
53167-0367
US

V. Phone/Fax

Practice location:
  • Phone: 262-331-4397
  • Fax:
Mailing address:
  • Phone: 262-514-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN M JOHNSON
Title or Position: GENERAL MANAGER
Credential:
Phone: 262-514-3242