Provider Demographics
NPI:1265474829
Name:BACK IN MOTION SARASOTA PHYSICAL
Entity type:Organization
Organization Name:BACK IN MOTION SARASOTA PHYSICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:941-925-2700
Mailing Address - Street 1:PO BOX 25066
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2066
Mailing Address - Country:US
Mailing Address - Phone:941-925-2700
Mailing Address - Fax:941-925-7744
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG E, UNIT G
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-925-2700
Practice Address - Fax:941-925-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22415225100000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1922055342OtherNPI FOR INDIVIDUAL PT
FL009615900Medicaid
FLU7566ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
FL5720410001Medicare NSC