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General NPI Number Information
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NPI Number | 1346582491
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Entity Type | Organization
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Legal Business Name | BACK-N-ACTION PT LLC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 500 BIRCH ST
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City | PARK FALLS
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State | WI
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Zip | 54552-1415
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Country | US
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Telephone | 715-762-1515
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Fax | 715-762-1599
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Provider Business Mailing Address
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Address Line | 500 BIRCH ST
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City | PARK FALLS
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State | WI
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Zip | 54552-1415
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Country | US
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Telephone | 715-762-1515
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Fax | 715-762-1599
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Authorized Official
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Title or Position | OWNER
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Name | NANCY T NESBIT
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Credential |
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Telephone | 715-762-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3939
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License Number State | WI
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