Provider Demographics
NPI:1598035289
Name:BACK IN MOTION PHYSICAL THERAPY. LLC
Entity Type:Organization
Organization Name:BACK IN MOTION PHYSICAL THERAPY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:LURON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-380-5825
Mailing Address - Street 1:5210 N ROAD 68
Mailing Address - Street 2:SUITE F
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9276
Mailing Address - Country:US
Mailing Address - Phone:509-380-5825
Mailing Address - Fax:509-380-5826
Practice Address - Street 1:5210 N ROAD 68
Practice Address - Street 2:SUITE F
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9276
Practice Address - Country:US
Practice Address - Phone:509-380-5825
Practice Address - Fax:509-380-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT00009869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty