Healthcare Provider Details

I. General information

NPI: 1396946729
Provider Name (Legal Business Name): BACK IN ACTION REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MILWAUKEE DR
NEW HOLSTEIN WI
53061
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 920-898-4440
  • Fax:
Mailing address:
  • Phone: 920-922-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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