=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770496317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEURO MOTION THERAPY & FITNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2026
-----------------------------------------------------
Last Update Date | 09/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 606 10TH ST
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-299-4171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 606 10TH ST
-----------------------------------------------------
City | HOLLY HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32117-3366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-299-4171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. OLGA BECKWITH
-----------------------------------------------------
Credential | PTA
-----------------------------------------------------
Telephone | 386-299-4171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------