Healthcare Provider Details

I. General information

NPI: 1295483980
Provider Name (Legal Business Name): BACK TO IT THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 04/24/2022
Certification Date: 04/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 SILVER SADDLE DR (I WILL BE A MOBILE PRACTICE WITHOUT PRIMARY LOCATION)
LK HAVASU CTY AZ
86406-6263
US

IV. Provider business mailing address

3285 SILVER SADDLE DR
LK HAVASU CTY AZ
86406-6263
US

V. Phone/Fax

Practice location:
  • Phone: 469-230-9158
  • Fax:
Mailing address:
  • Phone: 469-230-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. STANTON REHKEMPER
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 480-696-1050