Provider Demographics
NPI:1972727360
Name:BACK IN MOTION PHYSICAL THERAPY & SPINE CENTER PC
Entity Type:Organization
Organization Name:BACK IN MOTION PHYSICAL THERAPY & SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KWAPISINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-675-0699
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:2900 US HWY 12 SUITE J
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-0362
Mailing Address - Country:US
Mailing Address - Phone:815-675-0699
Mailing Address - Fax:815-675-0689
Practice Address - Street 1:2900 N US HIGHWAY 12 STE J
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:IL
Practice Address - Zip Code:60081-8322
Practice Address - Country:US
Practice Address - Phone:815-675-0699
Practice Address - Fax:815-675-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015875225100000X
IL111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632004OtherBLUE CROSS BLUE SHIELD
IL1437205325OtherINDIVIDUAL NPI OF LPT
IL1932214665OtherINDIVIDUAL NPI
IL1730371915OtherINDIVIDUAL NPI OF DPT
IL1730371915OtherINDIVIDUAL NPI OF DPT
IL1932214665OtherINDIVIDUAL NPI