Provider Demographics
NPI:1235516790
Name:BACKWORKS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BACKWORKS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNULL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:630-513-2700
Mailing Address - Street 1:2445 DEAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-513-2700
Mailing Address - Fax:630-513-2703
Practice Address - Street 1:2445 DEAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-513-2700
Practice Address - Fax:630-513-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty