MEDICARE: ADVANCED INTEGRATIVE MOVEMENT, LLC

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	PT00004067	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0212356	OTHER	WA	L & I

General Provider Information

NPI Number	:	1649389271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INTEGRATIVE MOVEMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11009
Second Line	:	CASCADE BILLING
City	:	OLYMPIA
State	:	WA
Zip	:	98508-1009
Country	:	US
Telephone Number	:	360-352-2037
Fax Number	:	360-352-0637

Provider Business Practice Location Address
First Line	:	3000 LIMITED LN NW
Second Line	:	SUITE 100
City	:	OLYMPIA
State	:	WA
Zip	:	98502-2704
Country	:	US
Telephone Number	:	360-292-7245
Fax Number	:	360-292-7247

Authorized Official
Title or Position	:	OWNER THERAPIST
Name	:	KURT W MOSS
Credential	:	PT
Telephone Number	:	360-292-7245

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	03/10/2010

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