MEDICARE: BACK IN MOTION PHYSICAL THERAPY & SPORTS MEDICINE, 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	261QP2000X	Physical Therapy Clinic/Center	10028024	WI

General Provider Information

NPI Number	:	1295744894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN MOTION PHYSICAL THERAPY & SPORTS MEDICINE, INC

Provider Business Mailing Address
First Line	:	4722 FARWELL ST
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9412
Country	:	US
Telephone Number	:	608-838-7232
Fax Number	:	608-838-7405

Provider Business Practice Location Address
First Line	:	4722 FARWELL ST
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-9412
Country	:	US
Telephone Number	:	608-838-7232
Fax Number	:	608-838-7405

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRIAN M DOOLAN
Credential	:	DPT
Telephone Number	:	608-838-7232

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	09/11/2023

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