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General NPI Number Information
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NPI Number | 1407005812
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Entity Type | Organization
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Legal Business Name | BACK IN ACTION, SAINT LUCIE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 266 NW PEACOCK BLVD BUILDING 2 SUITE 2-204
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-2271
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Country | US
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Telephone | 772-408-6630
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Fax | 772-408-6750
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Provider Business Mailing Address
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Address Line | PO BOX 7666
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34985-7666
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Country | US
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Telephone | 772-408-6630
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Fax | 772-408-6750
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK SAPIO DOCUMENTO
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Credential |
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Telephone | 772-408-6630
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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 | PT20821
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License Number State | FL
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