MEDICARE: BACK IN ACTION PHYSICAL THERAPY INC.

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	2251S0007X	Sports Physical Therapist	PT17119	CA
2	2251X0800X	Orthopedic Physical Therapist	PT17119	CA
3	225100000X	Physical Therapist	PT17119	CA

General Provider Information

NPI Number	:	1497053318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK IN ACTION PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	12526 HIGH BLUFF DR STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2067
Country	:	US
Telephone Number	:	888-713-2220
Fax Number	:	858-793-0704

Provider Business Practice Location Address
First Line	:	12544 HIGH BLUFF DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3050
Country	:	US
Telephone Number	:	888-713-2220
Fax Number	:	858-793-0704

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	COLETTE M. COINER
Credential	:
Telephone Number	:	888-713-2220

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	02/07/2026

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