Healthcare Provider Details

I. General information

NPI: 1205070596
Provider Name (Legal Business Name): BACK IN MOTION PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 SW 27TH AVE
MIAMI FL
33145-3415
US

IV. Provider business mailing address

901 S STATE ROAD 7
PLANTATION FL
33317-4522
US

V. Phone/Fax

Practice location:
  • Phone: 305-849-7400
  • Fax: 305-858-1100
Mailing address:
  • Phone: 954-636-6999
  • Fax: 954-636-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERT OTANO
Title or Position: DIRECTOR
Credential:
Phone: 305-859-7400