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General NPI Number Information
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NPI Number | 1295483980
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Entity Type | Organization
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Legal Business Name | BACK TO IT THERAPY LLC
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 3285 SILVER SADDLE DR (I WILL BE A MOBILE PRACTICE WITHOUT PRIMARY LOCATION)
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City | LK HAVASU CTY
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State | AZ
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Zip | 86406-6263
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Country | US
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Telephone | 469-230-9158
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Fax |
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Provider Business Mailing Address
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Address Line | 3285 SILVER SADDLE DR
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City | LK HAVASU CTY
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State | AZ
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Zip | 86406-6263
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Country | US
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Telephone | 469-230-9158
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. STANTON REHKEMPER
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Credential | PT, DPT
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Telephone | 480-696-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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