Provider Demographics
NPI:1154063154
Name:BACK TO ACTION PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BACK TO ACTION PHYSICAL THERAPY LLC
Other - Org Name:REDCORE PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH WALDO
Authorized Official - Middle Name:T
Authorized Official - Last Name:CUARTERO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:347-701-6228
Mailing Address - Street 1:9 HARBOR FRONT CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1951
Mailing Address - Country:US
Mailing Address - Phone:718-509-9888
Mailing Address - Fax:718-509-6144
Practice Address - Street 1:9 HARBOR FRONT CT
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1951
Practice Address - Country:US
Practice Address - Phone:718-509-9888
Practice Address - Fax:718-509-6144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty