1346633849 NPI number — THERAPY IN MOTION INC

Table of content: (NPI 1346633849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346633849 NPI number — THERAPY IN MOTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY IN MOTION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346633849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 404
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAVA HOT SPRINGS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83246-0404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-776-5125
Provider Business Mailing Address Fax Number:
866-287-2315

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 WEST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVA HOT SPRINGS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-776-5125
Provider Business Practice Location Address Fax Number:
866-287-2315
Provider Enumeration Date:
03/09/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FLEMING
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
208-776-5125

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  LCSW-29011 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)