Healthcare Provider Details

I. General information

NPI: 1508670332
Provider Name (Legal Business Name): BACK IN ACTION FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 W ATLANTIC AVE STE B12
DELRAY BEACH FL
33445-3897
US

IV. Provider business mailing address

4731 W ATLANTIC AVE STE B12
DELRAY BEACH FL
33445-3897
US

V. Phone/Fax

Practice location:
  • Phone: 561-935-7715
  • Fax: 561-774-2793
Mailing address:
  • Phone: 561-935-7715
  • Fax: 561-774-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN PLUNKETT
Title or Position: OWNER
Credential: DC
Phone: 561-935-7715