Provider Demographics
NPI:1699816033
Name:BACK IN MOTION REHABILITATION-SAGINAW, LLC
Entity Type:Organization
Organization Name:BACK IN MOTION REHABILITATION-SAGINAW, LLC
Other - Org Name:BACK IN MOTION REHABILITATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PROULX
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:989-799-9150
Mailing Address - Street 1:4884 GRATIOT RD
Mailing Address - Street 2:#19
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6270
Mailing Address - Country:US
Mailing Address - Phone:989-799-9150
Mailing Address - Fax:989-799-9153
Practice Address - Street 1:4884 GRATIOT RD
Practice Address - Street 2:#19
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6270
Practice Address - Country:US
Practice Address - Phone:989-799-9150
Practice Address - Fax:989-799-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003656225100000X
MI5501011534225100000X
MI5201001462225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650G312OtherBCBS GROUP PROVIDER #
MIP22210004Medicare PIN
MIP22210002Medicare PIN
MI0P22210Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
MIP22210005Medicare PIN