Provider Demographics
NPI:1932539715
Name:BACK IN MOTION PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BACK IN MOTION PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-952-1000
Mailing Address - Street 1:23517 MAIN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23517 MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5251
Practice Address - Country:US
Practice Address - Phone:310-952-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28882261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy