MEDICARE: BACK IN MOTION PHYSICAL THERAPY

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

General Provider Information

NPI Number	:	1205070596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN MOTION PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	901 S STATE ROAD 7
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-4522
Country	:	US
Telephone Number	:	954-636-6999
Fax Number	:	954-636-8060

Provider Business Practice Location Address
First Line	:	2109 SW 27TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3415
Country	:	US
Telephone Number	:	305-849-7400
Fax Number	:	305-858-1100

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GILBERT OTANO
Credential	:
Telephone Number	:	305-859-7400

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	04/30/2009

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