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General NPI Number Information
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NPI Number | 1922296045
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Entity Type | Organization
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Legal Business Name | BACK-N-ACTION PHYSICAL THERAPY AND REHAB SPECIALISTS
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 04/27/2010
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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 | PO BOX 3497
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City | STURTEVANT
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State | WI
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Zip | 53177-0300
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Country | US
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Telephone | 877-552-2996
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Fax | 866-245-8064
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Authorized Official
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Title or Position | OWNER
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Name | LARRY D. BRIAND
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Credential |
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Telephone | 877-552-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 37-039
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License Number State | WI
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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 | 3939-024
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License Number State | WI
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