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General NPI Number Information
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NPI Number | 1164735155
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & WELLNESS IN MOTION, INC
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 145 CYPRESS POINT PKWY SUITE 104
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City | PALM COAST
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State | FL
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Zip | 32164-8426
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Country | US
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Telephone | 386-274-2520
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Fax | 386-274-2521
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Provider Business Mailing Address
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Address Line | 2441 BELLEVUE AVE EXTENSION
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City | DAYTONA BEACH
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State | FL
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Zip | 32114
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Country | US
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Telephone | 386-274-2520
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Fax | 386-274-2521
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Authorized Official
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Title or Position | PRESIDENT/PHYSICAL THERAPIST
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Name | MR. SCOTT WAYNE TYREE
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Credential | MPT
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Telephone | 386-274-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 25452
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License Number State | FL
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