MEDICARE: BACK IN MOTION PHYISICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376590042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN MOTION PHYISICAL THERAPY INC

Provider Business Mailing Address
First Line	:	2109 SW 27TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3415
Country	:	US
Telephone Number	:	305-859-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1373 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4622
Country	:	US
Telephone Number	:	305-859-7400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GILBERTO OTANO
Credential	:
Telephone Number	:	305-859-7400

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	05/31/2024

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