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General NPI Number Information
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NPI Number | 1629841408
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Entity Type | Organization
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Legal Business Name | IN MOTION PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 559 W TWINCOURT TRL UNIT 610
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8805
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Country | US
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Telephone | 904-671-0255
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Fax | 904-671-0256
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Provider Business Mailing Address
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Address Line | 559 W TWINCOURT TRL UNIT 610
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8805
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Country | US
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Telephone | 904-671-0255
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Fax | 904-671-0256
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Authorized Official
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Title or Position | OWNER
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Name | JOHN K WIEST
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Credential |
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Telephone | 904-671-0255
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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 |
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License Number State |
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