MEDICARE: IN MOTION THERAPY, INC.

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	PT1160	MS

General Provider Information

NPI Number	:	1346492139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN MOTION THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1542
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-1542
Country	:	US
Telephone Number	:	601-764-4125
Fax Number	:	601-764-4125

Provider Business Practice Location Address
First Line	:	14 N THIRD ST STE B
Second Line	:
City	:	BAY SPRINGS
State	:	MS
Zip	:	39422-9798
Country	:	US
Telephone Number	:	601-764-4125
Fax Number	:	601-764-4125

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MR. LYNWOOD HIGHTOWER III
Credential	:
Telephone Number	:	601-764-4125

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	01/08/2009

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