Provider Demographics
NPI:1821368481
Name:BACK IN MOTION REHABILITATION, LLC
Entity Type:Organization
Organization Name:BACK IN MOTION REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-892-4557
Mailing Address - Street 1:946 W MIDLAND RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AUBURN
Mailing Address - State:MI
Mailing Address - Zip Code:48611-9400
Mailing Address - Country:US
Mailing Address - Phone:989-892-4557
Mailing Address - Fax:989-892-4686
Practice Address - Street 1:946 W MIDLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9400
Practice Address - Country:US
Practice Address - Phone:989-892-4557
Practice Address - Fax:989-892-4686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK IN MOTION REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1710987482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty