Provider Demographics
NPI:1053504266
Name:FLUID MOTION PHYSCIAL THERAPY,INC
Entity type:Organization
Organization Name:FLUID MOTION PHYSCIAL THERAPY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:304-766-0757
Mailing Address - Street 1:5639 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1017
Mailing Address - Country:US
Mailing Address - Phone:304-766-0757
Mailing Address - Fax:304-766-0758
Practice Address - Street 1:5639 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1017
Practice Address - Country:US
Practice Address - Phone:304-766-0757
Practice Address - Fax:304-766-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy