Provider Demographics
NPI:1043879018
Name:BACK2ACTIVITY PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BACK2ACTIVITY PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:806-663-2602
Mailing Address - Street 1:1814 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-3610
Mailing Address - Country:US
Mailing Address - Phone:806-419-1168
Mailing Address - Fax:806-419-1169
Practice Address - Street 1:1500 N HOBART ST
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-4126
Practice Address - Country:US
Practice Address - Phone:806-419-1168
Practice Address - Fax:806-419-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty