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General NPI Number Information
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NPI Number | 1790002095
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Entity Type | Organization
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Legal Business Name | BACK IN MOTION THERAPY INC.
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 3146 CROWNVIEW DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-6414
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Country | US
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Telephone | 310-918-0765
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Fax | 310-547-3886
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Provider Business Mailing Address
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Address Line | 3641 CROWN VIEW DRIVE
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City | RPV
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State | CA
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Zip | 90275-6414
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Country | US
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Telephone | 310-918-0765
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN ANTHONY BERKOVICH
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Credential | P.T.
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Telephone | 310-918-0765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT26104
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License Number State | CA
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