Healthcare Provider Details

I. General information

NPI: 1922296045
Provider Name (Legal Business Name): BACK-N-ACTION PHYSICAL THERAPY AND REHAB SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BIRCH ST
PARK FALLS WI
54552-1415
US

IV. Provider business mailing address

PO BOX 3497
STURTEVANT WI
53177-0300
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-1515
  • Fax: 715-762-1599
Mailing address:
  • Phone: 877-552-2996
  • Fax: 866-245-8064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3939-024
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number37-039
License Number StateWI

VIII. Authorized Official

Name: LARRY D. BRIAND
Title or Position: OWNER
Credential:
Phone: 877-552-2996