Healthcare Provider Details

I. General information

NPI: 1740481779
Provider Name (Legal Business Name): BACK IN ACTION REHABILITATION, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N8218 STATE ROAD 28
MAYVILLE WI
53050-2126
US

IV. Provider business mailing address

103 S PIONEER RD # 100
FOND DU LAC WI
54935-3871
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHARON WUNSCH
Title or Position: OFFICE MANAGER
Credential:
Phone: 920-922-7776