Provider Demographics
NPI:1295744894
Name:BACK IN MOTION PHYSICAL THERAPY & SPORTS MEDICINE, INC
Entity type:Organization
Organization Name:BACK IN MOTION PHYSICAL THERAPY & SPORTS MEDICINE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:608-838-7232
Mailing Address - Street 1:4722 FARWELL ST
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-9412
Mailing Address - Country:US
Mailing Address - Phone:608-838-7232
Mailing Address - Fax:608-838-7405
Practice Address - Street 1:4722 FARWELL ST
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-9412
Practice Address - Country:US
Practice Address - Phone:608-838-7232
Practice Address - Fax:608-838-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10028024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy