MEDICARE: INMOTION THERAPY PTA PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	006159	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1043865652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INMOTION THERAPY PTA PLLC

Provider Business Mailing Address
First Line	:	1806 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-532-4030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4302
Country	:	US
Telephone Number	:	718-532-4030
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IVAN ST. LOUIS
Credential	:	PTA
Telephone Number	:	631-220-0655

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	10/03/2019

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