Provider Demographics
NPI:1912149253
Name:BACK IN MOTION THERAPY, PC
Entity Type:Organization
Organization Name:BACK IN MOTION THERAPY, PC
Other - Org Name:BACK IN MOTION THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:812-709-0454
Mailing Address - Street 1:319 6TH STREET
Mailing Address - Street 2:PO BOX 575
Mailing Address - City:SHOALS
Mailing Address - State:IN
Mailing Address - Zip Code:47581-0575
Mailing Address - Country:US
Mailing Address - Phone:812-709-0454
Mailing Address - Fax:614-807-6433
Practice Address - Street 1:1764 TROY RD.
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501
Practice Address - Country:US
Practice Address - Phone:812-709-0454
Practice Address - Fax:614-807-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007803A261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1891867818Medicare PIN