Provider Demographics
NPI:1174740708
Name:PRO-MOTION PHYSICAL THERAPY AND FUNCTIONAL FITNESS P.C.
Entity type:Organization
Organization Name:PRO-MOTION PHYSICAL THERAPY AND FUNCTIONAL FITNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, MOMT
Authorized Official - Phone:509-573-4816
Mailing Address - Street 1:2006 W LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2406
Mailing Address - Country:US
Mailing Address - Phone:509-573-4816
Mailing Address - Fax:509-573-4825
Practice Address - Street 1:2006 W LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2406
Practice Address - Country:US
Practice Address - Phone:509-573-4816
Practice Address - Fax:509-573-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601-738-216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty