Healthcare Provider Details

I. General information

NPI: 1548378979
Provider Name (Legal Business Name): BACK IN ACTION, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 KAIPII ST
KAILUA HI
96734-2033
US

IV. Provider business mailing address

755 KAIPII ST
KAILUA HI
96734-2033
US

V. Phone/Fax

Practice location:
  • Phone: 808-284-6550
  • Fax:
Mailing address:
  • Phone: 808-284-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2007
License Number StateHI

VIII. Authorized Official

Name: DR. JOANNA MARIE BILANCIERI
Title or Position: PRESIDENT
Credential: DPT
Phone: 808-284-6550