MEDICARE: BACK IN MOTION PHYSICAL THERAPY 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	PT292441	CA

General Provider Information

NPI Number	:	1922594175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN MOTION PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	1831 WILSHIRE BLVD STE E
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5779
Country	:	US
Telephone Number	:	424-354-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1831 WILSHIRE BLVD STE E
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5779
Country	:	US
Telephone Number	:	424-354-9633
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	JANET MARISSA RUIZ
Credential	:	DPT
Telephone Number	:	310-699-1162

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	02/25/2020

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