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General NPI Number Information
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NPI Number | 1104155944
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Entity Type | Organization
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Legal Business Name | CREATIVE MOTION, INC
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 5907 W. MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75604
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Country | US
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Telephone | 903-759-6500
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Fax | 903-759-6500
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Provider Business Mailing Address
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Address Line | 5907 W. MARSHALL AVE
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City | LONGVIEW
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State | TX
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Zip | 75604
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Country | US
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Telephone | 903-759-6500
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Fax | 903-759-6500
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Authorized Official
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Title or Position | OWNER
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Name | MRS. WANDA BELL
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Credential | PT
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Telephone | 903-759-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1110948
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 105205
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1110948
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License Number State | TX
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