Provider Demographics
NPI:1790002095
Name:BACK IN MOTION THERAPY INC.
Entity Type:Organization
Organization Name:BACK IN MOTION THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BERKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:310-918-0765
Mailing Address - Street 1:3641 CROWN VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:RPV
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6414
Mailing Address - Country:US
Mailing Address - Phone:310-918-0765
Mailing Address - Fax:
Practice Address - Street 1:3146 CROWNVIEW DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-6414
Practice Address - Country:US
Practice Address - Phone:310-918-0765
Practice Address - Fax:310-547-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty