=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851507503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY IN MOTION HOME PT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 12/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4740 HUNTING TRL
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-281-1403
-----------------------------------------------------
Fax | 561-433-8981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4740 HUNTING TRL
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33467-3526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-281-1403
-----------------------------------------------------
Fax | 561-433-8981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT
-----------------------------------------------------
Name | DANA B UNSELL
-----------------------------------------------------
Credential | P.T.
-----------------------------------------------------
Telephone | 561-281-2403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 3526
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------