Provider Demographics
NPI:1205070596
Name:BACK IN MOTION PHYSICAL THERAPY
Entity type:Organization
Organization Name:BACK IN MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:OTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-859-7400
Mailing Address - Street 1:901 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4522
Mailing Address - Country:US
Mailing Address - Phone:954-636-6999
Mailing Address - Fax:954-636-8060
Practice Address - Street 1:2109 SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3415
Practice Address - Country:US
Practice Address - Phone:305-849-7400
Practice Address - Fax:305-858-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686834Medicare Oscar/Certification