=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366764623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INMOTION THERAPY SERVICES (DBA)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2010
-----------------------------------------------------
Last Update Date | 02/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10334 INTERLAKE AVE N
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98133-9414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-850-2511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 75324
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98175-0324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-850-2511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/PRESIDENT
-----------------------------------------------------
Name | JILL JANDREAU
-----------------------------------------------------
Credential | MSPT
-----------------------------------------------------
Telephone | 206-850-2511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 8342
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------