Healthcare Provider Details

I. General information

NPI: 1497053318
Provider Name (Legal Business Name): BACK IN ACTION PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 02/07/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12544 HIGH BLUFF DR STE 200
SAN DIEGO CA
92130-3050
US

IV. Provider business mailing address

12526 HIGH BLUFF DR STE 300
SAN DIEGO CA
92130-2067
US

V. Phone/Fax

Practice location:
  • Phone: 888-713-2220
  • Fax: 858-793-0704
Mailing address:
  • Phone: 888-713-2220
  • Fax: 858-793-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17119
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT17119
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17119
License Number StateCA

VIII. Authorized Official

Name: COLETTE M. COINER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 888-713-2220