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General NPI Number Information
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NPI Number | 1740481779
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Entity Type | Organization
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Legal Business Name | BACK IN ACTION REHABILITATION, S.C.
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | N8218 STATE ROAD 28
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City | MAYVILLE
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State | WI
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Zip | 53050-2126
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Country | US
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Telephone | 920-387-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 103 S PIONEER RD # 100
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City | FOND DU LAC
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State | WI
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Zip | 54935-3871
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHARON WUNSCH
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Credential |
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Telephone | 920-922-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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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