Provider Demographics
NPI:1932248754
Name:BACK IN MOTION REHABILITATION, LLC
Entity Type:Organization
Organization Name:BACK IN MOTION REHABILITATION, LLC
Other - Org Name:BACK IN MOTION REHABILITATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-450-3341
Mailing Address - Street 1:804 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5620
Mailing Address - Country:US
Mailing Address - Phone:989-450-3341
Mailing Address - Fax:989-778-1237
Practice Address - Street 1:2618 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6300
Practice Address - Country:US
Practice Address - Phone:989-892-4557
Practice Address - Fax:989-892-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008385225100000X, 225100000X
MI5501003708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104940040Medicaid
MI104940086Medicaid
MI104940012Medicaid
MI650Z910740OtherBCBS PROVIDER NUMBER
MI650Z910540OtherBCBS PROVIDER NUMBER
MI670Z901080OtherBCBS PROVIDER NUMBER
MI0N85070Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MI104940040Medicaid