1659493906 NPI number — IN MOTION ADVISORY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659493906 NPI number — IN MOTION ADVISORY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IN MOTION ADVISORY, LLC
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:
6
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:
1659493906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12845 FM 2154 RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
COLLEGE STATION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77845-4046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-696-4800
Provider Business Mailing Address Fax Number:
979-695-6947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12845 FM 2154 RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
COLLEGE STATION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77845-4046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-696-4800
Provider Business Practice Location Address Fax Number:
979-695-6947
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THORNTON
Authorized Official First Name:
KELLI
Authorized Official Middle Name:
DEANN
Authorized Official Title or Position:
PHYSICAL THERAPIST CO-OWNER
Authorized Official Telephone Number:
979-696-4800

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  651320001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE5710 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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