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General NPI Number Information
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NPI Number | 1649389271
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Entity Type | Organization
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Legal Business Name | ADVANCED INTEGRATIVE MOVEMENT, LLC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 3000 LIMITED LN NW SUITE 100
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City | OLYMPIA
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State | WA
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Zip | 98502-2704
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Country | US
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Telephone | 360-292-7245
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Fax | 360-292-7247
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Provider Business Mailing Address
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Address Line | PO BOX 11009 CASCADE BILLING
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City | OLYMPIA
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State | WA
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Zip | 98508-1009
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Country | US
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Telephone | 360-352-2037
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Fax | 360-352-0637
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Authorized Official
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Title or Position | OWNER THERAPIST
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Name | KURT W MOSS
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Credential | PT
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Telephone | 360-292-7245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT00004067
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License Number State | WA
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