Organization
BACK IN MOTION LOUISIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY ERIC BURNELL PT (PRESIDENT)
(941) 685-3665
Entity
Organization
Contact information
Practice address
1414 N CAUSEWAY BLVD, MANDEVILLE, LA 70471-3104
(941) 685-3665
Mailing address
PO BOX 894, MADISONVILLE, LA 70447-0894
(941) 685-3665
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT04010
LA
Other
Enumeration date
05/20/2015
Last updated
08/26/2015
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