Healthcare Provider Details

I. General information

NPI: 1376590042
Provider Name (Legal Business Name): BACK IN MOTION PHYISICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4622
US

IV. Provider business mailing address

2109 SW 27TH AVE
MIAMI FL
33145-3415
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-7400
  • Fax:
Mailing address:
  • Phone: 305-859-7400
  • Fax:

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: GILBERTO OTANO
Title or Position: PRESIDENT
Credential:
Phone: 305-859-7400