MEDICARE: BACK TO IT THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1295483980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO IT THERAPY LLC

Provider Business Mailing Address
First Line	:	3285 SILVER SADDLE DR
Second Line	:
City	:	LK HAVASU CTY
State	:	AZ
Zip	:	86406-6263
Country	:	US
Telephone Number	:	469-230-9158
Fax Number	:

Provider Business Practice Location Address
First Line	:	3285 SILVER SADDLE DR
Second Line	:	(I WILL BE A MOBILE PRACTICE WITHOUT PRIMARY LOCATION)
City	:	LK HAVASU CTY
State	:	AZ
Zip	:	86406-6263
Country	:	US
Telephone Number	:	469-230-9158
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. STANTON REHKEMPER
Credential	:	PT, DPT
Telephone Number	:	480-696-1050

Provider Enumeration Date	:	03/13/2022
Last Update Date	:	04/24/2022

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