# BACK IN MOTION LOUISIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285013573
- **Authorized official:** TIMOTHY ERIC BURNELL PT (PRESIDENT)
- **Authorized official phone:** (941) 685-3665

## Contact information

- **Practice address:** 1414 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3104
- **Practice address phone:** (941) 685-3665
- **Mailing address:** PO BOX 894, MADISONVILLE, LA 70447-0894
- **Mailing address phone:** (941) 685-3665

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT04010 | LA | Yes |

## Other

- **Enumeration date:** 05/20/2015
- **Last updated:** 08/26/2015