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General NPI Number Information
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NPI Number | 1356621395
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Entity Type | Organization
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Legal Business Name | BACK IN ACTION PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1001 E BOGARD RD
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City | WASILLA
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State | AK
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Zip | 99654-7114
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Country | US
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Telephone | 907-376-2225
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Fax | 907-376-9225
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Provider Business Mailing Address
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Address Line | 1001 E BOGARD RD
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City | WASILLA
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State | AK
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Zip | 99654-7114
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Country | US
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Telephone | 907-372-7246
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Fax | 907-376-9225
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. KRISTOFER D LARSON
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Credential | D.C.
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Telephone | 907-376-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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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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